papers

Health reform, health insurance, and mental health care

Am J Psychiatry 169:675-677.

Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Family Foundation, Washington, DC; Rollins School of Public Health, Emory University, Atlanta, GA, USA

The Affordable Care Act of 2010 (ACA) aims to make broad changes to the structure of the U.S. health care system and includes a host of provisions to improve access to insurance, restructure care delivery, and improve quality of care. Most notably, the law aims to expand insurance coverage through the extension of Medicaid to all low-income individuals, subsidies to help those with moderate incomes purchase coverage on their own, and establishment of health insurance exchanges to create a more organized and competitive market for health insurance. Nearly four million currently uninsured individuals with significant mental health needs are expected to gain coverage, leading to an increase in utilization of mental health services (1).

The analysis by Barry et al. in this issue (2) highlights one of the challenges that behavioral health presents to the implementation of the ACA: adverse selection in health insurance exchanges. Exchanges represent a new mechanism for purchasing insurance, offering enrollees a menu of health plans with common rules regarding coverage and pricing and also providing information to help consumers understand their coverage options. Exchanges will be state based, and enrollees primarily will include middle-income individuals who are currently uninsured or who currently purchase coverage through the nongroup market (3).