Mental Health Coverage in Health Care Reform

描述（由申请人提供）：一个创新的和潜在的影响深远的组成部分，病人保护和负担得起的医疗法案（ACA）是创造新的国家一级的健康保险市场被称为“交流。“从2014年1月1日起，没有资格获得雇主赞助或公共保险的美国公民和法律的居民将能够通过新的交易所购买医疗保险，巩固和规范个人保险市场。通过交易所提供的计划将涵盖联邦政府定义的“基本福利一揽子计划”，其中包括精神卫生保健的平等覆盖。保费和费用分摊补贴将按比例适用于收入不超过贫困水平400%的个人和家庭。将基于交易所的保险扩大到约2 400万人，有望改善获得精神保健的机会，提供财政保护，并将低收入群体纳入保健主流。然而，过去30年来经济学和心理健康的一个核心教训是，私人健康保险市场的竞争和选择并不能满足精神病患者（和其他慢性病患者）的需求。危险在于：为了避免在私人健康保险市场上进行风险的“逆向选择”，交换计划可能会系统地提供精神和其他慢性疾病的护理。 该项目建议对精神病患者使用医疗保健的模式进行基础经济研究，以便为在交易所构建健康保险市场的合理选择建立证据基础。我们计划评估可能的交易所参与者中选择问题的严重性，并在此基础上，确定和评估纠正健康计划激励措施的方案，为精神疾病患者提供有效和公平的保险。总之，我们打算：1）使用来自医疗支出小组调查（MEPS）的多年全国代表性数据，测量可能参与交易的人群中逆向选择的激励强度，并测试选择驱动的激励是否比其他条件更有利于心理健康。我们将研究在个人和家庭层面的选择激励措施。2)评估健康保险交易所设计选择激励的后果，包括：风险调整、风险分担、止损、分拆和有限的计划选择。在统一的理论和经验框架内定量地比较替代方案。 目标是指导政策，以避免过去在精神健康和个人私人健康保险市场上的陷阱。这一建议响应了弗朗西斯柯林斯的呼吁，致力于国家卫生研究院的研究工作，以造福卫生保健改革。

DESCRIPTION (provided by applicant): An innovative and potentially far-reaching component of The Patient Protection and Affordable Care Act (ACA) is creation of new state-level health insurance markets referred to as "Exchanges." As of January 1, 2014, U.S. citizens and legal residents who are not eligible for employer-sponsored or public coverage will be able to purchase health insurance through new Exchanges, consolidating and regulating the market for individual insurance. Plans offered through the Exchanges will cover a federally defined "essential benefit package," which includes parity in coverage for mental health care. Premium and cost-sharing subsidies will apply on a sliding scale for individuals and families earning up to 400% of poverty. Extension of Exchange-based insurance to an estimated 24 million people promises to improve access to mental health care, provide financial protection, and integrate low-income groups into the mainstream of health care. A central lesson of economics and mental health in the past 30 years, however, is that competition and choice in private health insurance markets does not meet the needs of persons with mental illness (and other chronic conditions). The danger is: to avoid drawing an "adverse selection" of risks in a private health insurance market, Exchange plans may systematically under provide care for mental and other chronic illnesses. This project proposes to conduct fundamental economic research on the patterns of health care use by persons with mental illness in order to establish the evidence base for sound choices about structuring health insurance markets in the Exchanges. We plan to assess the magnitude of the selection problem among likely Exchange participants, and based on this, identify and evaluate options for correcting incentives to health plans to provide efficient and fair coverage for person with mental illness. In summary, we intend to: 1) Measure the strength of incentives for adverse selection among populations likely to participate in Exchanges using multiple years of nationally representative data from the Medical Expenditure Panel Survey (MEPS), and test whether selection-driven incentives are greater for mental health than other conditions. We will examine selection incentives at the individual and family level. 2) Evaluate the consequences for selection incentives of design choices in health insurance Exchanges, including: risk adjustment, risk-sharing, stop-losses, carve-outs, and limited choice of plans. Compare alternatives quantitatively within a unified theoretical and empirical framework. The goal is to guide policy so as to avoid pitfalls of the past in mental health and individual private health insurance markets. This proposal responds to Frances Collins' call to devote NIH research effort to benefit health care reform.