title: The impact of national health care reform on adults with severe mental disorders.
abstract: OBJECTIVE
  Little is known about the effect recent health care reform legislation will have on coverage of individuals with severe mental disorders. The authors examined current and predicted sources of insurance coverage and use of mental health services among adults with and without severe mental disorders and modeled postreform changes.
  
  
  METHODS
  The authors obtained sociodemographic, health status, mental health care use, and insurance coverage data from the 2004-2006 Medical Expenditure Panel Surveys to estimate changes that will occur after reform is fully implemented in 2019.
  
  
  RESULTS
  Adults with severe mental disorders, identified as self-reported severe depression or other psychological distress, were more likely than those without such disorders to be uninsured (21.0% compared with 16.5%). Only one-fifth of individuals with severe mental disorders who lacked full-year insurance coverage had any mental health service use in the 2004-2006 period, compared with approximately half of those who had coverage. The authors estimate that the expansion of insurance coverage under reform will lead to 1.15 million new users of mental health services, which represents a 4.5% increase. The authors estimate an increase of 2.3 million users of mental health services in Medicaid and nearly 2 million in private insurance.
  
  
  CONCLUSIONS
  Public insurance programs that currently play a major role in financing mental health services will play an even greater role after reform is implemented. Significant increases can be expected both in the overall number of users of mental health services and in their resources to pay for care.
authors.affiliation: Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, USA. rachelg@kff.org
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Garfield
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Zuvekas
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
mesh_terms: D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence; D005102:Health Expenditures; D006801:Humans; D007182:Income; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration / Q000706:statistics & numerical data; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D057216:Propensity Score; D014481:United States; D055815:Young Adult