title: Insurance Coverage and Treatment Use Under the Affordable Care Act Among Adults With Mental and Substance Use Disorders.
abstract: OBJECTIVE
  Many adults who have mental or substance use disorders or both experience insurance-related barriers to care, contributing to low treatment utilization. Expanded insurance under the Affordable Care Act (ACA) could improve coverage and access. The study identified changes in coverage and treatment use following 2014 ACA insurance expansions.
  
  
  METHODS
  Data from the National Survey on Drug Use and Health were used to identify individuals ages 18-64 screening positive for any mental disorder (N=29,962) or substance use disorder (N=19,243) for two periods: 2011-2013 and 2014. Regression-adjusted means were calculated for insurance rates and treatment used in each period overall and among individuals with household incomes ≤200% of the federal poverty level (FPL).
  
  
  RESULTS
  Compared with 2011-2013, in 2014 significant reductions were seen in the uninsured rate for individuals with mental disorders (-5.4 percentage points, p<.01) and substance use disorders (-5.1 percentage points, p<.01). Increases in insurance coverage occurred mostly through Medicaid. Insurance gains were larger for adults with incomes ≤200% of FPL compared with the overall sample. Use of mental health treatment increased by 2.1 percentage points (p=.04), but use of substance use disorder treatment did not change. No significant changes were noted in treatment settings for mental and substance use disorder treatments. Payment by Medicaid for substance use disorder treatment increased by 7.4 percentage points (p=.05).
  
  
  CONCLUSIONS
  Sizable increases in coverage for adults with mental disorders and adults with substance use disorders were identified in the year following the 2014 ACA expansions; however, low treatment rates among this population remain a concern. Initiatives to engage the newly insured in treatment are needed.
authors.affiliation: Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu ). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.
authors.forename: Brendan
authors.initials: B
authors.lastname: Saloner
authors.affiliation: Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu ). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.
authors.forename: Sachini
authors.initials: S
authors.lastname: Bandara
authors.affiliation: Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu ). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bachhuber
authors.affiliation: Dr. Saloner, Ms. Bandara, and Dr. Barry are with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: bsaloner@jhu.edu ). Dr. Bachhuber is with the Division of General Internal Medicine, Montefiore Hospital and Medical Center, Bronx, New York.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D011203:Poverty; D012044:Regression Analysis; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Affordable Care Act; Medicaid; access to care; insurance; mental health; substance use disorders