University of Minnesota study: After Affordable Care Act, inpatient psychiatric care rose and emergency department psychiatric care dropped for young adults

Monday, September 29, 2014

In 2010, the Affordable Care Act (ACA) expanded health care coverage to several million previously uninsured young adults.

Research out today from the School of Public Health at the University of Minnesota finds that the ACA’s young adult insurance expansion coincided with modest increases to inpatient mental health and inpatient substance abuse care utilization, while emergency department use for these disorders declined. Young adults were also less likely to be uninsured when they did use these hospital-based services.

The findings were published online today in the American Journal of Psychiatry.

“Our research is one of the first evaluations of the ACA’s coverage expansions that focuses on health services utilization,” said Ezra Golberstein, Ph.D., lead author of the study and assistant professor of health policy and management in the University of Minnesota School of Public Health. “Mental health and substance use disorders peak among young adults at a time in life when health insurance coverage is low. We found that the coverage expansion was associated with modestly higher inpatient use for these disorders, along with decreases in emergency department use.”

The study looked at national trends in inpatient use, and trends in emergency department use in California between 2005 and 2011, and focused on the ACA’s dependent coverage provision that allowed adults to stay on parents’ insurance policies until age 26. The research team, which included colleagues at Yale University, Dartmouth College and Harvard Medical School, compared trends in care for 19 to 25-year-olds who were targeted by the ACA’s coverage expansion to trends for 26 to 29-year-olds, who were not targeted by the ACA expansion.

Other key findings:

  • The likelihood that inpatient visits were uninsured dropped by 2.9 percentage points between 2005 and 2011. The likelihood that emergency department visits in California were uninsured dropped by 3.9 percentage points.
  • Men and women both saw increases in rates of inpatient use, but only women saw decreases in emergency department use.

Golberstein added, “The fact that we see reductions in emergency department use strikes us a good thing, suggesting that young adults were able to access mental health and substance use services in non-emergency settings.”

On the other hand, the authors note that it is not clear from the data whether increased inpatient use is a good or bad thing. If people were getting services that they really needed because of the insurance expansion that would be a good outcome. But if the services were only marginally effective, it might not be as good. This study helps lay the groundwork for understanding how the ACA is transforming mental health and substance abuse treatment in the United States, which researchers are only beginning to understand.