Closing Racial Disparities Through the Affordable Care Act: Medicaid Expansion, Marketplaces, Federally Qualified Community Health Centers

项目摘要/摘要 现已制定的《平价医疗法案》(ACA)为增进精神健康提供了机会 非洲裔美国人和白人的覆盖面和待遇，以及缩小差距。通过扩展 医疗补助覆盖收入达到或低于联邦贫困线(FPL)138%的成年人，提供 为收入在100%至400%之间的成年人提供购房补贴，并通过增加供应 在联邦合格的健康中心中，这些中心在全国范围内提供相当大的精神卫生保健 ACA尤其可以让没有保险的有精神健康问题的非裔美国人受益。我们知道的很少 关于ACA政策在多大程度上增加了精神疾病黑人和白人的覆盖和治疗。 使用全国药物使用与健康调查(NSDUH)的数据，卫生资源和服务 政府和各种医疗补助和市场数据来源，这项研究第一次询问 以下：18岁-患有轻中度精神疾病、严重精神疾病的人 (SMI)和严重心理困扰(SPD)，并在对个人社会人口进行控制后 与心理健康治疗的保险接受和/或接受相关的变量以及关键的州水平差异 我们问：(1)ACA医疗补助计划的扩大在多大程度上增加了医疗补助计划的覆盖范围，并减少了覆盖范围 差距？一些州的补充医疗补助要求如何限制了差距的缩小？ 1)ACA医疗补助覆盖范围增加了多少(2)FQHC可用性增加了多少，但缺乏其他 提供者的可用性减少了非裔美国人的心理健康治疗，并减少了非裔美国人- 白人差异？补贴购买的ACA市场增加了多少私人覆盖范围和 缩小差距？1)市场覆盖率(2)和更高的FQHC可用性增加了多少 增加，但缺乏其他提供者减少了对非裔美国人和 缩小非裔美国人和白人之间的差距？ACA是现状，提供证据很重要 关于非裔美国人的心理健康覆盖率和缩小治疗差距的监测 取得进展并指导未来缩小差距的政策和行政行动。

Project Summary/Abstract The now established Affordable Care Act (ACA) afforded an opportunity to increase mental health coverage and treatment for African Americans and whites and to reduce disparities. By extending Medicaid coverage to adults with incomes at or below 138% of the Federal Poverty Line (FPL), providing purchase subsidies for adults with incomes between 100% and 400% FPL, and by increasing the supply of Federally Qualified Health Centers which provide considerable mental health care nationwide, the ACA can benefit uninsured African Americans with mental health problems especially. We know little about how much ACA policies increased coverage and treatment for mentally ill Blacks and whites. Using data from the National Survey on Drug Use and Health (NSDUH), the Health Resources and Services Administration and from various Medicaid and marketplace data sources this study asks, for the first time, the following: For persons aged 18-64 with Mild and Moderate Mental Illness (MMMI), Serious Mental illness (SMI), and Serious Psychological Distress (SPD), and after controlling for individual socio-demographic variables related to insurance uptake and/or receipt of mental health treatment and key state-level differences we ask: (1) How much did the ACA Medicaid expansion increase Medicaid coverage and reduce coverage disparities? How was disparity reduction limited by some states’ supplemental Medicaid requirements? (2) How much did increases in 1) ACA Medicaid coverage (2) greater FQHC availability increase but lack of other provider availability decrease mental health treatment for African Americans and reduce African American- white disparities? How much did ACA marketplaces for subsidized purchase increase private coverage and reduce disparities? How much did increases in 1) marketplace coverage (2) and greater FQHC availability increase, but lack of other provider availability decrease mental health treatment for African Americans and reduce African American-white disparities? The ACA is status quo, and it is important to provide evidence concerning African American-white mental health coverage and treatment disparity reduction to monitor progress and guide future disparity reduction policy and administrative actions.