Public Health Insurance Expansions and Mental Health Care Availability Open Access

Spiewak, Max (Spring 2021)

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People living with mental illness face barriers when seeking mental health care, including provider shortages and poor geographic availability. Medicaid expansion under the Affordable Care Act (ACA) may have increased mental health treatment capacity, as previous expansions were associated with mental health sector employment gains. Little research to date has examined the impact of Medicaid expansion under the ACA on mental health care availability. Quasi-experimental studies are needed to estimate the effects of public health insurance expansions on the development of local mental health care systems. This study’s objective is to test the hypothesis that Medicaid expansion under the ACA increased the availability of mental health care resources, including mental health sector facilities and employees. Difference-in-difference models with two-way fixed effects were used estimate the impact of Medicaid expansion on county mental health care resources. Each additional year of Medicaid expansion predicts a 1.4% increase in the number of mental health care facilities per 100,000 residents in counties with mental health care after controlling for elected official ideology and factors influencing consumer demand (p < .01). Medicaid expansion was not associated with increased likelihood of having at least one mental health care facility in counties with inconsistent mental health care access (p > .05). Results indicate that Medicaid expansion improved mental health care availability in areas with established mental health care systems, but areas with developing mental health care systems may not have benefited. Targeted policies are needed to ensure that people throughout the United States can access mental health care.

Table of Contents


Chapter 1: Introduction

Chapter 2: Literature Review

Chapter 3: Methodology

Chapter 4: Results

Chapter 5: Discussion



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