Increased Health Insurance Coverage Needed for Patients with Mental Illness

Study finds passage of Affordable Care Act caused a spike in ER visits for young adults with mental illnesses and circulatory system disease.

A recent study published in Annals of Emergency Medicine found a significant increase following the Affordable Care Act (ACA) in emergency department (ER) visits for young adults with mental illnesses and circulatory system disease.

The study evaluated patient visits to the ER in California, Florida, and New York before and after the ACA was implemented.

In an effort to determine whether the ACA impacted these visits, researchers compared patients between the ages of 19 and 25 years from September 2009 through August 2010 versus patients between the ages of 26 and 31 years from January 2011 through December 2011.

The results of the study showed that after the ACA was in place, the relative risk rate of ER visits increased 2.6% for young adults with mental illness and 4.8% for circulatory system diseases such as cardiac dysrhythmias.

"The troubling finding is that young adults were more likely to visit the emergency department for mental illnesses following expanded insurance coverage under the ACA," said study author Renee Hsia, MD. "Significant barriers to care for mental health issues persist, leaving these patients little choice but to seek care in the only place they know they can get it: the ER."

Although the visits increased for these patients, researchers also found that the rate of ER visits decreased (0.5%) in young people, while the relative rate of visits decreased (3.7%) for pregnancy-related diagnoses.

There was also a decrease found among visits for skin diseases, such as cellulitis and abscesses (3.3%). Researchers concluded that the ER visit decreases were almost exclusively among white and black young adults.

"Increased health insurance coverage reduced ER visits by young people for conditions that can be treated in office-based settings, but the lack of mental health resources continues to bring these patients to the ER in ever larger numbers," Dr. Hsia said. "We also saw an increase in patients with diseases of the circulatory system, such as non-specific chest pain. There was a big decrease in ER visits for complications of pregnancy among young people, which is important as it was among the top reasons they visited the emergency department prior to the implementation of the ACA."