Abstract
One in five American adults experiences a mental illness in a given year, yet over 50% never receive treatment (National Alliance on Mental Illness). Further, 35% with a serious mental illness never receive treatment (Substance Abuse and Mental Health Administration). This treatment gap costs the U.S. over $100 billion a year in lost productivity and contributes to some of our country’s most pressing issues, from substance abuse to homelessness (Scientific American, 2012). The economic and social toll of untreated mental illness suggests government intervention is necessary to ensure that Americans who are mentally ill are able to access treatment. Barriers to mental health care range from cultural stigma to cost of treatment. The Affordable Care Act, which went into effect in 2014, intended to help address the cost barrier to care by including mental health as one of ten essential health benefits, requiring all Americans to obtain health insurance or pay a penalty, and providing subsidies to help low-income individuals pay for it. This thesis sought to understand whether the mental health provisions of the Affordable Care Act have effectively expanded access to care among those who need or want treatment. To analyze this effect, I applied a logistic regression to National Health Interview Survey responses from 2013 and 2016, examining health insurance status, mental health access, and a number of demographic variables. In addition, I interviewed mental health policy experts for their perspectives and insights into my results as well as their policy recommendations. The regression results suggest that individuals with health insurance are more likely to access mental health care and that the Affordable Care Act appears to have expanded access to care overall. However, even after the Affordable Care Act went into effect, individuals with private insurance were less likely to access care than those with public insurance, and African American, Asian, and Hispanic respondents were all less likely to access care than their white counterparts. Based on my qualitative interviews, these results appear to be fairly consistent with what advocates and policymakers observe. These findings have important policy implications. They suggest that the Affordable Care Act has helped expand access to care but policymakers should consider further reforms to ensure individuals with private insurance are able to access quality in-network care. They also indicate that additional reforms are necessary to address the persistent racial disparities in mental health care.