Implementation of Federal Mental Health Laws Show Early Successes; Remaining Challenges

Dec 15, 2016

ARLINGTON, Va., Dec. 15, 2016 – Two new studies looked at how two federal laws — the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MHPAEA), — impacted access to coverage for patients with mental illness. The research, published online today in Psychiatric Services in Advance, also suggests remaining challenges.

Researcher and sole author Peter Phalen, M.A., with the University of Indianapolis, looked at health insurance use following implementation of the Affordable Care Act and found that people with moderate mental illness benefited significantly from the law. Yet people with serious mental illness did not show similar benefits.

Phalen examined short-term changes in rates of health insurance coverage, use of mental health services, affordability of mental health services, and satisfaction with health coverage. He reviewed a nationally representative sample of more than 35,000 people ages 26 to 65 between 2013 and 2014, a period that encompassed the implementation of Medicaid expansions and health insurance exchanges in January 2014.

He found that individuals with moderate mental illness (identified based on a proxy measure of psychological distress) experienced greater improvements in rates of health insurance coverage and ease of finding an affordable health plan compared with individuals with no mental illness. Individuals with severe mental illness showed no relative improvements on these measures, although they did report net increases in satisfaction with health care and coverage. No net increases in health care use or affordability of needed health care were found for any group.

In a separate study, researchers from Optum, United Health Group, Eden Prairie, Minn. and from the University of California, Los Angeles, led by Amber Gayle Thalmayer, Ph.D, looked at how the MHPAEA, impacted the use of treatment limits. Prior to implementation of the law most commercial health care plans covered only a specific number of behavioral health treatment days or visits (called quantitative treatment limits or QTLs). The law prohibited these limits except in a few specific circumstances. The intent was to make continued treatment available to those who need it by not limiting treatment based on a predetermined fixed number of days or visits.

The researchers wanted to look at whether these treatments limits were still being used. They looked at data from 380 employers and nearly 6,000 plans for years 2008 to 2013. They found that after implementation of MHPAEA in 2010, virtually all plans had eliminated treatment limits.

Thalmayer and colleagues concluded that “one of the most meaningful impacts of MHPAEA might be increased access to needed specialty behavioral health care for children and adults with depression, bipolar disorder, or psychosis, who were most likely to reach their inpatient and outpatient limit thresholds pre-parity.” Other researchers on the study included Sarah A. Friedman, M.S.P.H., Francisca Azocar, Ph.D., Jessica M. Harwood, M.S., and Susan L. Ettner, Ph.D.

While they concluded that MHPAEA has been effective in eliminating treatment limits, they cautioned that “increasing access to behavioral health care will mean going beyond such QTL changes and looking at other areas of benefit management.”

The American Psychiatric Association is a national medical specialty society whose more than 36,500 physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders.

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