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The Effects of the Affordable Care Act on Mental Health in the United States

Bacon, Victoria (2020) The Effects of the Affordable Care Act on Mental Health in the United States. Master Essay, University of Pittsburgh.

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The Affordable Care Act (ACA) was a legislative attempt to improve public health across United States by addressing multiple health-related barriers and concerns. This statute included provisions to reduce the number of uninsured adults through the creation of insurance marketplaces and by expanding Medicaid coverage to people with a low income; however, not all states chose to expand Medicaid. In addition, the impact of the ACA and Medicaid expansion on mental health has not been closely analyzed.
Using data from the County Health Rankings & Roadmaps program, I investigated the impact of the ACA across states on overall mental health (measured as mean poor mental health days per month, PMHD), proportion of adults without health insurance, and median household income. Data were available for 3 years: 2011, 2015, and 2018. I assessed potential differences in these measures between states with federally-run versus state-run insurance marketplaces, as well as between expansion and non-expansion states.
Compared to states using federally-run marketplaces, states with state-run marketplaces had higher median household incomes ($57,668.04 versus $48,264, p=0.0001) and proportionately fewer adults without health insurance (9.97% versus 14.9%, p=0.0033). Individuals in states with state-run marketplaces reported fewer PMHD than citizens in states using the federally-run marketplace in 2011 (3.24 versus 3.43 days per month, p=0.04) and 2015 (3.26 versus 3.48 days per month, p=0.03), but not for 2018 (3.36 versus 3.50 days per month, p=0.13). However, neither PMHD nor change in PMHD over years, differed between expansion and non-expansion states (p>0.50 for all years).
Individuals in states with state-run insurance marketplaces had fewer PMHD than individuals in states with federally-run marketplaces, possibly due to technical issues with the federally-run marketplace that delayed implementation. PMHD did not differ significantly between states with or without Medicaid expansion, perhaps due to factors other than insurance, such as lack of providers or transportation to services or the lack of a strict, clinical measure of mental health outcomes.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Bacon, Victoriavab50@pitt.eduvab50
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairKammerer, Candacecmk3@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberVan Nostrand, Elizabethevannostrand@pitt.eduUNSPECIFIEDUNSPECIFIED
Date: 23 April 2020
Date Type: Submission
Submission Date: 28 March 2020
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 53
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Public Health Genetics
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: Mental Health; Affordable Care Act; ACA
Date Deposited: 02 Sep 2020 22:57
Last Modified: 02 Sep 2020 22:57

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