Summary
Summary: The Affordable Care Act (ACA) aimed to expand mental health service use in the U.S. by expanding access to health insurance. However, the gap in mental health utilization by race and ethnicity is pronounced: members of racial and ethnic minoritized groups remain less likely to use mental health services than non-Hispanic white individuals even after the ACA.
This study assessed the effect of the Affordable Care Act (ACA) on mental health services use in one large state (California), and whether that effect differed among racial and ethnic groups. Also, it tested for change in racial and ethnic disparities after the implementation of the ACA, using four measures of mental health care. Logistic regression and Generalized Linear Models (GLM) were estimated using pooled California Health Interview Survey (CHIS) data from 2011–2018. Disparities were defined using the Institute of Medicine (IOM) definition. Primary outcomes were any mental health care in primary settings; in specialty settings, any prescription medication for mental health problems, and number of annual visits to mental health services.
Findings: Findings suggested that the change in Hispanic-non-Hispanic white disparities in prescription medication use under the ACA was statistically significant, narrowing the gap by 7.23 percentage points. However, the disparity in other measures was not significantly reduced.
These findings suggest that the magnitude of the increase in primary and specialty mental health services among racial and ethnic minorities was not large enough to significantly reduce racial and ethnic disparities. One possible explanation is that nonfinancial factors played a role, such as language barriers, attitudinal barriers from home culture norms, and systemic barriers due to mental health professional shortages and a limited number of mental health care providers of color.
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