More people with schizophrenia have health insurance after Obamacare implementation

The national uninsured rate for adults under 65 with schizophrenia fell 50% after the Affordable Care Act (ACA) was implemented in 2014, according to a University of Massachusetts study. Amherst published this week in JAMA Psychiatry.

Also known as Obamacare, the Health Care Reform Act was designed to make health insurance more affordable and accessible to all Americans. Previous research has shown that the overall national under-65 uninsured rate decreased after the ACA took effect, from 16.6% in 2010 to 11.0% in 2021.

We weren’t sure if we would see the same with people with schizophrenia and were interested in looking at this because people with schizophrenia need ongoing care. It is a very serious chronic illness and it is very important to have insurance, but people with schizophrenia can experience many barriers to maintaining insurance. They are less likely to be employed and have higher social needs, among other things. »

Kimberley Geissler, Associate Professor of Health Policy and Management, UMass Amherst School of Public Health and Health Sciences

Before the Affordable Care Act, 8.4% of people with schizophrenia were uninsured, a lower rate than the general population, Geissler notes, because many people with schizophrenia may be eligible for Medicaid and/or or Medicare under the disability provisions.

Geissler and his team analyzed data from 2008 to 2020 from the Agency for Healthcare Research and Quality’s Medical Spending Panel Survey (MEPS). The sample totaled 9.173 million people with schizophrenia, defined as those who had had at least one medical appointment for the mental disorder over a two-year period. Researchers found a “significant reduction” in the percentage of uninsured people with schizophrenia after ACA. Before Obamacare, 8.4% were uninsured; after the ACA, the rate of uninsured people with schizophrenia fell to 4%.

“We’ve seen this decrease in uninsured primarily due to an increase in Medicaid coverage, which makes sense because Medicaid coverage has generally increased sharply with the ACA both due to expansion of Medicaid and the insurance mandate that is no longer in effect,” Geissler said. “People who didn’t know they were eligible or hadn’t applied for Medicaid before were able to get coverage after the ACA.”

Some 70% of policyholders with schizophrenia were covered by Medicaid after the ACA, compared to 61% before the ACA, the researchers calculated. Medicare coverage increased to 43% after the ACA, from 38% before the ACA. Private insurance coverage dropped slightly to 19% after the ACA, from 22% before the ACA.

Geissler says the results are an encouraging step toward universal coverage for people with schizophrenia. “I was happy to see that the uninsured rate is as low as it is. There are a lot of people who are now covered who weren’t before.”

The results also suggest that better care is available for this vulnerable patient population. “We know that having insurance improves a wide variety of outcomes, but we haven’t specifically examined whether this increased rate of insurance for people with schizophrenia is associated with increased access,” she says. . “We suspect that is the case, but we are not sure.”

The national uninsured rate for adults under 65 with schizophrenia fell 50% after the Affordable Care Act (ACA) was implemented in 2014, according to a University of Massachusetts study in Amherst published this week in JAMA Psychiatry.

Also known as Obamacare, the Health Care Reform Act was designed to make health insurance more affordable and accessible to all Americans. Previous research has shown that the overall national under-65 uninsured rate decreased after the ACA took effect, from 16.6% in 2010 to 11.0% in 2021.

“We didn’t know if we would see the same with people with schizophrenia and we were interested in looking at this because people with schizophrenia need ongoing care,” says Kimberley Geissler, associate professor of policy and management at health at UMass Amherst. School of Public Health and Health Sciences. “It is a very serious chronic condition and having insurance is very important, but people with schizophrenia can have many barriers to maintaining insurance. They are less likely to be employed and have higher social needs, among others.”

Before the Affordable Care Act, 8.4% of people with schizophrenia were uninsured, a lower rate than the general population, Geissler notes, because many people with schizophrenia may be eligible for Medicaid and/or or Medicare under the disability provisions.

Geissler and his team analyzed data from 2008 to 2020 from the Agency for Healthcare Research and Quality’s Medical Spending Panel Survey (MEPS). The sample totaled 9.173 million people with schizophrenia, defined as those who had had at least one medical appointment for the mental disorder over a two-year period. Researchers found a “significant reduction” in the percentage of uninsured people with schizophrenia after ACA. Before Obamacare, 8.4% were uninsured; after the ACA, the rate of uninsured people with schizophrenia fell to 4%.

“We’ve seen this decrease in uninsured primarily due to an increase in Medicaid coverage, which makes sense because Medicaid coverage has generally increased sharply with the ACA both due to expansion of Medicaid and the insurance mandate that is no longer in effect,” Geissler said. “People who didn’t know they were eligible or hadn’t applied for Medicaid before were able to get coverage after the ACA.”

Some 70% of policyholders with schizophrenia were covered by Medicaid after the ACA, compared to 61% before the ACA, the researchers calculated. Medicare coverage increased to 43% after the ACA, from 38% before the ACA. Private insurance coverage dropped slightly to 19% after the ACA, from 22% before the ACA.

Geissler says the results are an encouraging step toward universal coverage for people with schizophrenia. “I was happy to see that the uninsured rate is as low as it is. There are a lot of people who are now covered who weren’t before.”

The results also suggest that better care is available for this vulnerable patient population. “We know that having insurance improves a wide variety of outcomes, but we haven’t specifically examined whether this increased rate of insurance for people with schizophrenia is associated with increased access,” she says. . “We suspect that is the case, but we are not sure.”