The Impact of National Health Care Reform on Adults With Severe Mental Disorders
Abstract
Objective:
Method:
Results:
Conclusions:
Method
Data Sources
Data Analysis
Results
Current Income, Insurance Coverage, and Utilization
Mental Health Status Group | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Variable | Probable Depression | Serious Psychological Distress | Depression or Serious Psychological Distress | Neither Depression Nor Serious Psychological Distress | Full Sample | |||||
N | 95% CI | N | 95% CI | N | 95% CI | N | 95% CI | N | 95% CI | |
Person-year observations | 5,351 | 3,199 | 5,880 | 45,200 | 51,080 | |||||
Weighted population (1,000s) | 15,408 | 14,161–16,656 | 9,056 | 8,179–9,934 | 17,013 | 15,650–18,376 | 167,852 | 157,354–178,349 | 184,865 | 173,528–196,201 |
% | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | |
Family income relative to federal poverty line | ||||||||||
<133% | 40.8 | 38.7–42.9 | 46.9 | 44.4–49.3 | 40.7 | 38.7–42.7 | 17.7 | 16.8–18.6 | 19.9 | 19.0–20.8 |
133%–400% | 41.3 | 39.4–43.2 | 39.0 | 36.7–41.2 | 41.6 | 39.8–43.5 | 41.0 | 40.0–41.9 | 41.0 | 40.1–42.0 |
>400% | 17.9 | 16.2–19.6 | 14.2 | 12.3–16.0 | 17.6 | 16.0–19.3 | 41.3 | 40.0–42.6 | 39.1 | 37.8–40.3 |
Female | 57.8 | 55.9–59.8 | 59.4 | 56.7–62.2 | 58.0 | 56.0–59.9 | 50.0 | 49.5–50.5 | 50.8 | 50.2–51.3 |
Race/ethnicity | ||||||||||
Hispanic | 15.9 | 13.9–18.0 | 16.5 | 14.2–18.8 | 16.3 | 14.3–18.3 | 14.1 | 12.7–15.4 | 14.3 | 12.9–15.6 |
Black | 15.7 | 13.7–17.7 | 14.3 | 12.1–16.4 | 15.5 | 13.5–17.5 | 11.9 | 10.7–13.0 | 12.2 | 11.1–13.3 |
White | 62.6 | 59.9–65.4 | 64.4 | 61.3–67.6 | 62.5 | 59.7–65.2 | 68.3 | 66.6–70.1 | 67.8 | 66.0–69.5 |
Other | 5.8 | 4.4–7.1 | 4.8 | 3.5–6.0 | 5.8 | 4.5–7.0 | 5.8 | 5.0–6.5 | 5.8 | 5.0–6.5 |
Education | ||||||||||
Less than high school | 28.9 | 26.9–39.0 | 31.7 | 29.2–34.1 | 29.0 | 27.1–31.0 | 15.7 | 15.0–16.5 | 17.0 | 16.2–17.8 |
High school diploma | 36.9 | 34.9–38.9 | 36.6 | 34.0–39.2 | 36.6 | 34.7–38.5 | 30.5 | 29.6–31.5 | 31.1 | 30.2–32.1 |
Some college | 20.5 | 18.8–22.3 | 20.4 | 18.1–22.6 | 20.8 | 19.1–22.5 | 24.6 | 23.8–25.4 | 24.2 | 23.5–25.0 |
Bachelor's degree | 8.8 | 7.7–10.0 | 7.3 | 6.0–8.7 | 8.9 | 7.8–10.0 | 17.8 | 16.8–18.8 | 16.9 | 16.0–17.9 |
Advanced degree | 4.0 | 3.2–4.8 | 3.1 | 2.3–4.0 | 3.9 | 3.2–4.7 | 10.8 | 10.1–11.5 | 10.2 | 9.5–10.8 |
Census region | ||||||||||
Northeast | 16.7 | 14.3–19.2 | 17.0 | 14.1–19.9 | 16.9 | 14.4–19.4 | 18.7 | 16.8–20.6 | 18.5 | 16.6–20.4 |
Midwest | 20.2 | 17.9–22.6 | 20.5 | 17.6–23.3 | 20.2 | 17.8–22.6 | 22.4 | 20.3–24.6 | 22.2 | 20.1–24.3 |
South | 40.4 | 37.4–43.5 | 40.1 | 36.8–43.4 | 40.0 | 37.0–43.0 | 35.6 | 32.7–38.6 | 36.1 | 33.2–38.9 |
West | 22.6 | 18.9–26.3 | 22.4 | 19.0–25.9 | 22.9 | 19.2–26.6 | 23.2 | 20.1–26.3 | 23.2 | 20.1–26.2 |
Metropolitan Statistical Area residence | 81.4 | 78.5–84.3 | 79.9 | 76.5–83.2 | 81.4 | 78.5–84.3 | 83.9 | 81.8–86.1 | 83.7 | 81.5–85.8 |
Attitudes (disagree strongly or somewhat) | ||||||||||
Healthy enough, don't need insurance | 85.9 | 84.8–86.9 | 88.2 | 86.8–89.6 | 85.7 | 84.7–86.8 | 79.8 | 79.2–80.5 | 80.4 | 79.8–81.0 |
Health insurance not worth cost | 56.7 | 54.8–58.6 | 55.8 | 53.4–58.3 | 56.6 | 54.8–58.4 | 61.3 | 60.4–62.2 | 60.8 | 60.0–61.7 |
Take more risks than average person | 55.9 | 53.9–57.9 | 55.6 | 53.3–57.8 | 55.8 | 53.9–57.6 | 60.7 | 60.0–61.4 | 60.2 | 59.6–60.9 |
Overcome illness without medical help | 69.9 | 67.9–71.4 | 72.9 | 70.9–74.9 | 69.3 | 67.7–71.0 | 62.1 | 61.4–62.9 | 62.8 | 62.1–63.6 |
Mean | 95% CI | Mean | 95% CI | Mean | 95% CI | Mean | 95% CI | Mean | 95% CI | |
SF-12 Physical Health Summary | 43.2 | 42.6–43.8 | 41.5 | 40.8–42.2 | 43.3 | 42.8–43.9 | 52.1 | 52.0–52.3 | 51.3 | 51.1–51.4 |
Age | 42.0 | 41.5–42.5 | 42.1 | 41.4–42.8 | 41.8 | 41.4–42.3 | 40.2 | 40.0–40.4 | 40.4 | 40.1–40.6 |
Medicare Full Year | Private Full Year | Medicaid Full Year | Uninsured Part Year | Uninsured Full Year | Total Population, 2006 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mental Health Status Group and Income Relative to Federal Poverty Line | % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | % | 95% CI | N (1,000s) | |
Probable depression | ||||||||||||
<133% | 15.0 | 13.2–17.0 | 10.3 | 8.9–11.8 | 24.9 | 22.4–27.6 | 20.3 | 18.4–22.2 | 29.5 | 26.9–32.4 | 6,124 | |
133%–400% | 10.6 | 8.7–12.9 | 48.1 | 45.0–51.2 | 6.8 | 5.5–8.3 | 15.8 | 13.7–18.1 | 18.8 | 16.4–21.5 | 6,286 | |
>400% | 6.1 | 4.3–8.6 | 78.6 | 75.0–81.8 | —a | —a | 8.0 | 6.0–10.7 | 6.7 | 5.0–9.0 | 2,998 | |
All incomes | 11.6 | 10.4–12.9 | 38.1 | 36.2–40.1 | 13.1 | 11.7–14.5 | 16.2 | 15.0–17.6 | 21.0 | 19.3–22.8 | 15,408 | |
Serious psychological distress | ||||||||||||
<133% | 16.0 | 13.8–18.6 | 9.0 | 7.3–11.1 | 25.7 | 22.8–28.7 | 19.4 | 17.1–21.8 | 29.9 | 26.7–33.3 | 4,117 | |
133%–400% | 12.4 | 9.7–15.7 | 44.7 | 40.8–48.7 | 7.7 | 6.0–9.8 | 16.1 | 13.2–19.4 | 19.1 | 16.2–22.4 | 3,476 | |
>400% | 10.8 | 7.3–15.6 | 73.8 | 67.7–79.1 | —a | —a | 7.8 | 5.1–11.9 | 7.3 | 4.8–11.0 | 1,464 | |
All incomes | 13.9 | 12.2–15.7 | 32.1 | 29.8–34.5 | 15.1 | 13.4–16.8 | 16.4 | 14.9–18.1 | 22.5 | 20.4–24.7 | 9,056 | |
Probable depression or serious psychological distress | ||||||||||||
<133% | 14.7 | 13.0–16.6 | 10.8 | 9.4–12.4 | 25.2 | 22.8–27.8 | 19.9 | 18.2–21.7 | 29.4 | 26.9–32.1 | 6,701 | |
133%–400% | 10.4 | 8.6–12.7 | 48.0 | 45.1–50.9 | 6.6 | 5.4–8.0 | 16.1 | 14.1–18.3 | 18.9 | 16.6–21.4 | 7,107 | |
>400% | 5.6 | 3.9–8.0 | 79.2 | 75.8–82.3 | —a | —a | 7.9 | 6.0–10.4 | 6.8 | 5.1–9.0 | 3,205 | |
All incomes | 11.3 | 10.2–12.6 | 38.4 | 36.5–40.3 | 13.1 | 11.8–14.5 | 16.2 | 15.0–17.4 | 21.0 | 19.4–22.8 | 17,013 | |
Neither probable depression nor serious psychological distress | ||||||||||||
<133% | 5.2 | 4.7–5.8 | 21.2 | 19.9–22.6 | 16.2 | 14.8–17.6 | 19.2 | 18.1–20.4 | 38.1 | 36.5–39.8 | 29,922 | |
133%–400% | 1.8 | 1.5–2.0 | 62.8 | 61.5–64.1 | 2.6 | 2.3–3.0 | 13.9 | 13.3–14.5 | 18.9 | 17.8–20.1 | 68,078 | |
>400% | 0.6 | 0.5–0.8 | 88.8 | 87.9–89.7 | —a | —a | 5.5 | 4.9–6.1 | 4.8 | 4.2–5.5 | 69,851 | |
All incomes | 1.9 | 1.7–2.1 | 66.2 | 65.1–67.3 | 4.1 | 3.7–4.4 | 11.4 | 10.9–11.9 | 16.5 | 15.7–17.3 | 167,852 |
Postreform Changes in Coverage
Coverage | Users | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline | Postreform | Change | Baseline | Postreform | Change | |||||||
Group and Coverage | N (1,000s) | % | N (1,000s) | % | N (1,000s) | % | N (1,000s) | % | N (1,000s) | % | N (1,000s) | % |
Probable depression or serious psychological distress | ||||||||||||
Medicare | 1,907 | 11.2 | 1,907 | 11.2 | 0 | 0.0 | 1,216 | 18.0 | 1,216 | 17.0 | 0 | 0.0 |
Medicaid | 2,174 | 12.8 | 4,162 | 24.5 | 1,988 | 91.5 | 1,052 | 16.0 | 1,965 | 28.0 | 913 | 86.8 |
Private | 6,674 | 39.2 | 8,391 | 49.3 | 1,717 | 25.7 | 2,550 | 39.0 | 3,122 | 44.0 | 572 | 22.4 |
Uninsured part year | 2,729 | 16.0 | 1,113 | 6.5 | –1,615 | –59.2 | 998 | 15.0 | 407 | 6.0 | –591 | –59.2 |
Uninsured full year | 3,530 | 20.7 | 1,440 | 8.5 | –2,090 | –59.2 | 759 | 12.0 | 310 | 4.0 | –449 | –59.2 |
Total | 17,013 | 100.0 | 17,013 | 100.0 | 0 | 0.0 | 6,575 | 100.0 | 7,019 | 100.0 | 445 | 6.8 |
Neither probable depression nor serious psychological distress | ||||||||||||
Medicare | 3,182 | 2.0 | 3,182 | 2.0 | 0 | 0.0 | 1,169 | 6.0 | 1,169 | 6.0 | 0 | 0.0 |
Medicaid | 6,843 | 4.0 | 17,292 | 10.0 | 10,449 | 152.7 | 1,089 | 6.0 | 2,471 | 13.0 | 1,382 | 126.8 |
Private | 111,161 | 66.0 | 128,338 | 76.0 | 17,177 | 15.5 | 13,158 | 70.0 | 14,519 | 74.0 | 1,361 | 10.3 |
Uninsured part year | 19,032 | 11.0 | 7,765 | 5.0 | –11,267 | –59.2 | 1,953 | 10.0 | 797 | 4.0 | –1,156 | –59.2 |
Uninsured full year | 27,634 | 16.0 | 11,275 | 7.0 | –16,359 | –59.2 | 1,483 | 8.0 | 605 | 3.0 | –878 | –59.2 |
Total | 167,852 | 100.0 | 167,852 | 100.0 | 0 | 0.0 | 18,853 | 100.0 | 19,561 | 100.0 | 709 | 3.8 |
Full population | ||||||||||||
Medicare | 5,089 | 3.0 | 5,089 | 3.0 | 0 | 0.0 | 2,385 | 9.0 | 2,385 | 9.0 | 0 | 0.0 |
Medicaid | 9,017 | 5.0 | 21,453 | 12.0 | 12,437 | 137.9 | 2,142 | 8.0 | 4,436 | 17.0 | 2,295 | 107.1 |
Private | 117,835 | 64.0 | 136,730 | 74.0 | 18,894 | 16.0 | 15,708 | 62.0 | 17,641 | 66.0 | 1,932 | 12.3 |
Uninsured part year | 21,760 | 12.0 | 8,878 | 5.0 | –12,882 | –59.2 | 2,950 | 12.0 | 1,204 | 5.0 | –1,747 | –59.2 |
Uninsured full year | 31,164 | 17.0 | 12,715 | 7.0 | –18,449 | –59.2 | 2,242 | 9.0 | 915 | 3.0 | –1,327 | –59.2 |
Total | 184,865 | 100.0 | 184,865 | 100.0 | 0 | 0.0 | 25,427 | 100.0 | 26,581 | 100.0 | 1,154 | 4.5 |
Postreform Changes in Use
Discussion
Acknowledgments
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