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

项目总结/摘要 现在制定的《平价医疗法案》（ACA）为提高心理健康水平提供了机会。 为非裔美国人和白人提供覆盖和治疗，并减少差距。通过扩展 医疗补助覆盖收入等于或低于联邦贫困线（FPL）138%的成年人， 为收入在100%至400% FPL之间的成年人提供购买补贴， 在全国范围内提供大量精神卫生保健的联邦合格卫生中心中， ACA可以使没有保险的非洲裔美国人特别是精神健康问题。我们知之甚少 关于ACA政策增加了多少对精神病黑人和白人的覆盖和治疗。 使用全国药物使用和健康调查（NSDUH）的数据，卫生资源和服务 这项研究第一次从各种医疗补助和市场数据来源中提出， 以下：18至64岁患有轻度及中度精神病、严重精神病 (SMI)，和严重心理困扰（SPD），并在控制个人社会人口统计学 与保险吸收和/或接受心理健康治疗有关的变量以及关键的州一级差异 我们问：（1）ACA医疗补助计划的扩大增加了多少医疗补助覆盖率，减少了多少覆盖率 差距？一些州的补充医疗补助要求是如何限制差距缩小的？（二） 有多少增加1）ACA医疗补助覆盖率（2）更大的CMEHC可用性增加，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- 白色差异？ACA补贴购买市场增加了多少私人保险， 缩小差距？1）市场覆盖率（2）和更高的CNOHC可用性增加了多少 增加，但缺乏其他提供者，减少了非裔美国人心理健康治疗， 减少非裔美国人和白人之间的差距ACA是现状，重要的是提供证据 关于非洲裔美国人-白人精神健康覆盖率和治疗差异减少监测 推动并指导今后减少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.