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Study Shows Sharp Jump in Young Adult ER, Mental Health Care Under Health Law

By John Reichard, CQ HealthBeat Editor

September 24, 2014 -- Young adults under the age of 26 who had access to employer-sponsored health insurance used sharply more emergency room services and substance abuse and mental health treatment the year after the health law extended that type of coverage to their age cohort, according to newly released data. The health law (PL 111-148, PL 111-152) required employer-sponsored plans to cover members' children up to age 26 for family policies issued or renewed after September 23, 2010.

Researchers at the Health Care Cost Institute noted the rise in young adult use of those services may not be entirely attributable to the law and could be due to other factors, including changes in public policy, insurance benefits, or the health of the population. The findings were contained in an issue brief released last week.

Other analysts suggested the health law was a big factor.

Policymakers can likely count the overhaul as a success in fueling an increase in mental health and substance abuse treatment of young adults, said Ken Duckworth, medical director of the National Alliance for the Mentally Ill (NAMI). But it's adding to difficulties lining up treatment because the supply of beds and doctors isn't keeping up, he said.

The Health Care Cost Institute maintains the largest U.S. database of private insurance claims.

Prior to the passage of the law, many children lost coverage upon turning 19, the institute noted. Young adult enrollment rose 3.1 million, or 10.4 percent, between the fall 2010 and the end of 2011, according to federal data. Almost all of that growth was in private coverage.

It's plausible the covered group in 2011 included young people with previously unmet needs, institute researchers said in an interview. But the design of the study did not allow that proposition to be proven or disproven, they cautioned.

"We did not separate out people who gained insurance" from those who already had it, said senior researcher Amanda Frost.

Spending on emergency room (ER) visits by young covered adults rose 15.6 percent in 2011 after growing only 4.6 percent the year before. The number of ER visits per 1,000 young adults increased by 10.4 percent in 2011, the study said.

Spending on hospital admissions for mental health and substance use jumped 52.3 percent in 2011 after growing 30 percent the year before. The increase in spending was largely due to an increase in the number of these admissions. Mental health parity legislation (PL 110-343) intended to increase access to mental health care also could have played a role, the researchers said.

NAMI's Duckworth noted the difficulty of explaining the uptick because there were "a lot of moving parts" at play in 2011 other than the health law. They included the sluggish economy and growing abuse of prescription painkillers and other opioids.

Unlike other types of medical care, people tend to use more mental health and substance abuse treatment in a troubled economy. "There's more anxiety, more depression, more substance abuse," he said.

But "the fact that the Affordable Care Act brought young adults into the insurance game I think was going to predictably impact mental health/substance abuse spending. There are a lot of young adults who didn't have insurance before. They're not all going to be healthy and free of vulnerabilities," he said.

Duckworth said it's a public health triumph that more troubled young people are getting care but now policy makers "need to be thinking about what 'does it take to increase our supply of providers'?"

"It takes a very long time to make a child psychiatrist. It takes roughly about a decade from the day you enter medical school."

"Access to these services is a concern in many parts of the country. If you talked to people who worked in emergency rooms they would feel this increase in the visits. One of the areas that they're having the most trouble is getting people into mental health beds," he said.

Duckworth said he sees the rise in ER use found in the study as linked to the rise in demand for mental health/substance abuse care. "Virtually no inpatient psych or detox facility will take you unless you've been evaluated in an emergency room."

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