Health reform doesn't increase admissions for behavioral disorders

Health reforms that increased access to coverage in Massachusetts and served as the archetype for the national healthcare law did not increase hospital utilization among young people diagnosed with behavioral health disorders, according to a study released this week.

The study, published online Feb. 19 in JAMA Psychiatry, looked at inpatient admissions before and after the state's implementation of comprehensive health reform in 2006.

The law, which was signed by then-Gov. Mitt Romney, was praised at the time for providing near universal coverage, but became a point of political derision during the 2012 presidential campaign when it was cited as the model for provisions within the Patient Protection and Affordable Care Act.

Critics of the ACA have argued an expansion of health coverage would result in higher healthcare costs as more newly insured individuals sought care.

The findings in this study showed hospital admission rates after 2006 for adults between ages 19 and 25 declined by an absolute of 2 per 1,000 patients where any behavioral health disorder was the primary diagnosis, .38 per 1,000 for depression and 1.3 per 1,000 for substance abuse. The number of uninsured among this age group also fell after 2006 from 26% to 10%.

“Expanded health insurance coverage for young adults is not associated with large increases in hospital-based care for behavioral health,” according to the study. “But it increased financial protection to young adults with behavioral health diagnoses and to the hospitals that care for them.”

Emergency department visits for behavioral health diagnoses increased after 2006 but at a slower rate compared with Maryland, the study found, while hospital discharges for uninsured young people with behavioral disorders decreased by 5 percentage points for both inpatients and visitors of the emergency department relative to other states. Maryland was chosen for comparison purposes because it has a similar number of mental health patients, a similar number of mental health providers and similar rates of utilization to Massachusetts prior to the adoption of the health reform law.

An estimated half of all mental health disorders occur by age 14, according to the Substance Abuse and Mental Health Services Administration, with 75% occurring by age 24.

Treatment for mental health and substance abuse is among the 10 essential benefits included in the ACA that required insurers to provide for beginning this year. It is believed the protections offered within the health reform law coupled with the issuing last November of the final rule to the 2008 Mental Health Parity and Addiction Equity Act, which requires health plans covering most of the population to offer similar deductibles, copayments and limits for both mental health and medical and surgical services, will provide comprehensive coverage for millions diagnosed with mental health disorders.

Follow Steven Ross Johnson on Twitter: @MHSjohnson