Effects of Insurance Expansions on Mental Health Outcomes

Background: Recent health insurance expansions provided mixed evidence in terms of immediate changes in health for individuals eligible for expanded coverage. Results for mental health have been less ambiguous. Evidence from the Oregon Health Insurance Experiment suggested immediate improvement in self-reported health among those eligible for the expanded Medicaid slots. The dependent coverage mandate of the Affordable Care Act also led to improved self-reported mental health among the group of eligible young adults. Further work found that the effect was concentrated among women and among those with more symptoms of mental illness. This research seeks to investigate whether the broader insurance expansions associated with the Affordable Care Act, including the Medicaid expansion, led to improved mental health.

Aims of the Study: We assess the effects of the Medicaid expansion and broader overall ACA insurance expansions on mental well-being focusing on broad outcomes and the range of possible mechanisms. We seek to understand how potential improvements (or degradations) differ across the risk profile. Gains among individuals who are at low risk for severe mental health issues may send a far different signal than gains among those with higher risks.

Methods: Using MEPS data from 2011 through 2016, we use a difference-in-differences design to compare pre/post outcomes across the distribution of risk for adults likely to benefit from the Medicaid expansion in states that expanded their program compared to similar individuals in states that did not expand. We also use variation in pre-ACA uninsured rates to develop inference with regard to the effects of the ACA overall, including the marketplaces and mandates. Our work also digs into differences between men and women and by race/ethnicity. To gauge the effects of the mandate on mental health, we use the Mental Component Score measure within the MEPS, as well as other self-reported mental health measures.

Results: Preliminary results suggest improvements in self-reported mental health for individuals following the ACA expansions. The gains do not appear to be equal across the risk distribution, however. Results suggest that self-reported mental health improved in both Medicaid expansion states as well as non-expansion states. As we continue to find that broad expansions of insurance coverage lead to improvements in self-reported mental health, identifying the precise mechanism for such effects becomes crucial for policy feedback. We will probe changes in access to services as well as improved financial security as likely mechanisms. We also attempt to understand how much of these gains might be a “halo effect” of gaining coverage, rather than a direct benefit of the coverage itself.