Increasing Access to Health Care for Young Adults With Mental Illness

The health care landscape seems to be shifting every day, to the point that it is impossible to know what health insurance will look like for Americans 6 months from now. A constant for many years has been that young adults are the least likely age group to have health insurance. While most young adults are relatively physically healthy, this insurance gap places a disproportionate burden on those with mental illness. These young people need to be able to access health care services, since around three-fourths of all mental disorders start by age 24 years. Moreover, young adults with mental illness tend to have worse physical health and will die around 10 years earlier than their peers without mental illness.

In 2010, as a provision of the Affordable Care Act, private health insurance coverage was extended to individuals up to age 26 years under their parents’ plans. Over 3 million uninsured young adults gained health insurance between September 2010 and December 2011, increasing rates of coverage by over 10%. My colleague and I set out to study the effect of the dependent coverage expansion on young adults with mental illness. We examined data from the National Survey on Drug Use and Health, using a difference-in-differences approach to compare young adults with mental illness subject to the provision with a slightly older sample, both before and after the expansion. We found that, relative to the older sample, young adults’ private health insurance coverage increased by almost 12% following the expansion and uninsurance decreased by almost 9%. This translated into modest changes for young adults with mental illness. Specifically, the proportion who received outpatient mental health treatment at least monthly on average increased by 2% and the proportion reporting their overall health as fair or poor decreased by 2%. In those with more serious mental illness, unmet mental health needs due to cost decreased by over 12%. These findings translate into hundreds of thousands of young Americans overcoming a major barrier to accessing mental health care.

Since this article was published, I moved back to my hometown of Toronto, Canada, where I work as a psychiatrist treating adolescents and young adults. Despite a system of universal health care, many young people have difficulty accessing mental health services in Canada, too. Historically, medications and psychotherapies have not been covered in our system of universal health care. However, in early 2018, my province started covering full prescription drug costs for Ontarians under the age of 25 years. To create a better health care system, it is critical for policymakers and researchers to study the impacts of initiatives such as these on health outcomes, health care utilization, and overall costs. As clinicians, these issues are also highly relevant to us. We can only provide effective care for our patients when they can access our services.

Financial disclosure:Dr Kozloff has no relevant personal financial relationships to report. Her spouse is a consultant for Sanofi and RTI Health Solutions, has received grant/research support from Sanofi and Regeneron, and has received honoraria from Astellas Canada, Prime Inc, and Spire Learning.