Mental Health Coverage in Health Care Reform

描述（由申请人提供）：《患者保护和平价医疗法案》（ACA）的一个创新和潜在影响深远的组成部分是建立新的国家级健康保险市场，即“交易所”。自2014年1月1日起，没有资格获得雇主资助或公共保险的美国公民和合法居民将能够通过新的交易所购买医疗保险，从而巩固和规范个人保险市场。医保交易所提供的计划将涵盖联邦政府规定的“基本福利计划”，其中包括精神卫生保健的平等保险。保费和费用分摊补贴将以浮动比例适用于收入高达贫困水平400%的个人和家庭。将基于交易所的保险扩大到大约2400万人，有望改善获得精神卫生保健的机会，提供财务保护，并将低收入群体纳入卫生保健的主流。然而，过去30年经济学和心理健康的一个中心教训是，私人健康保险市场的竞争和选择不能满足精神病（和其他慢性疾病）患者的需要。危险在于：为了避免在私人健康保险市场上造成风险的“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。该项目建议对精神疾病患者使用保健服务的模式进行基础经济研究，以便为在交易所建立健康保险市场的合理选择建立证据基础。我们计划在可能的交换参与者中评估选择问题的严重程度，并在此基础上，确定和评估纠正健康计划激励的选择，以为精神疾病患者提供有效和公平的覆盖。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来衡量可能参与交换的人群中逆向选择激励的强度，并测试选择驱动的激励是否对心理健康比其他状况更大。我们将研究个人和家庭层面的选择动机。2)评估健康保险交易中设计选择对选择激励的影响，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比较备选方案。目标是指导政策，以避免过去精神健康和个人私人健康保险市场的陷阱。该提案回应了弗朗西斯·柯林斯（Frances Collins）的呼吁，即将NIH的研究努力用于医疗改革。

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. PUBLIC HEALTH RELEVANCE: As of January 1, 2014, US citizens and legal residents who are not eligible for employer- sponsored or public coverage will be able to purchase health insurance through new state-level health insurance markets, referred to as "Exchanges." 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.