The National Bureau of Economic Research report suggests an increase in mental health care access among young adults after the Affordable Care Act. This article explores that fact in detail.

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ACA Improves Young Adults’ Access to
Mental Health Care
Lack of access to mental health care has been a problem
among young adults in the U.S.
In addition to the social stigma
that surrounds mental health
disorders, lack of insurance
coverage and limitation to
mental health care services are
among the major reasons for this
dilemma. However, the National
Bureau of Economic Research
(NBER) released a report in
June which says the Affordable
Care Act (ACA) improves the
access to mental healthcare
among young adults. As per the
report, expanded coverage for young adults under this
healthcare reform significantly increased inpatient hospital
visits related to mental health. The healthcare law allows
young adults under age 26 to stay on their parents’ group
insurance plans started in late 2010.
NBER Study - Key Findings
 The overall number of inpatient visits related to
mental health among young adults aged 19-25 years
increased to 3.5 percent compared to people aged 27
to 29 who could not be staying on their parents’ plans.

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 After the implementation of ACA, mental health
admissions of young adults increased by 9 percent.
 As a result of the Obamacare implementation, the
number of young adults with private insurance in the
treatment group involved in the survey increased by
2.1 and 6 percentage points.
 The number of young adults without health insurance
in the treatment group involved in the survey
decreased by a marginally statistically significant 1
percent and statistically significant 2.9 percentage
since the enactment and implementation of the
healthcare reform.
 The national study revealed that a major portion of
psychiatric admissions came through the emergency
department.
 While dividing mental health category into
subcategories of depression, psychoses and other
mental illnesses using the relevant ICD 9 codes during
the study, large and statistically significant increases
were found in all inpatient admissions and visits
through the emergency room (ER) for depression post
Obamacare. The study observed a sizable increase in
psychoses admissions as well.

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The results from the study are slightly confusing as the
experts say when Massachusetts expanded medical
coverage with its 2006 state-based health reform law, no
significant increases were found in the number of mental-
health hospitalizations for young adults there. In the
opinion of healthcare experts, community caregivers may
have largely met the needs of newly insured people saving
them from visiting ERs for critical care.
Three Ways in which ACA Enhances Mental Health
Care Access
 ACA builds on the Mental Health Parity and
Addictions Equity Act in order to expand mental
health and substance use disorder benefits and federal
parity protections for more than 60 million people in
the U.S., which is one of the biggest expansions in
behavioral health coverage.
 Under the healthcare law, insurance companies can no
longer deny healthcare coverage or charge more
because of a pre-existing health condition including
mental illness.
 Most healthcare plans must cover preventive services
including depression screening for adults at no cost as
per this law.
Challenges for Hospitals with Improved Access

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Rise in inpatient psychiatric services is surely a positive
sign to hospitals as they will get more reimbursement.
However, this trend poses several challenges to healthcare
organizations as well, such as:
 Managing Surge with Limited Resources – As the
number of inpatient visits increases, hospitals will
have to manage their healthcare needs with the
resources they already have. A 2012 Treatment
Advocacy Center report reveals a significant shortage
in the number of psychiatric beds nationwide from
2005-2010. The healthcare reform will also impel the
use of advanced patient care technologies. In such a
scenario, hospital executives will require to
accomplish a huge task of managing a delivery system
in which more patients will be chasing fewer
resources.
 Increased Public Scrutiny – As several patients get
insured newly with the health care reform, they will
seek help from litigators and activists to understand
more about the coverage. They will handle patients’
complaints against the level of care and as a result
hospitals can expect an increase in lawsuits and public
exposure.
 Financial Burden – Young adults who don’t want to
stay under parents’ coverage may qualify for Medicaid
under provisions of Obamacare which expand health
care coverage to individuals who earns up to 138
percent of the federal poverty level, depending on

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their income and the location where they dwell. But,
hospitals face a reduction of $14.1 billion from FY
2014 through 2019 in Medicaid Disproportionate
Share Payment (DSH) under Obamacare. Young
adults staying under parents’ coverage may sometimes
qualify for tax subsidies depending on their income.
This will require hospitals to verify insurance
documents thoroughly before the actual visit.
 Shortage of Psychiatrists – A recent report suggests
that psychiatrists are in short supply nationwide. Thus,
the hospital executives should not only manage the
surge of inpatient visits with limited resources, but
with fewer practicing psychiatrists as well.
Hospitals will require the help of professionals to manage
the revenue cycle amidst these challenges and receive
proper reimbursement without any delay.