Most New to Medicaid Have No Other Option if Affordable Care Act Repealed

“Lots of Ohioans support the ACA — but where do @ohiogop #OHGOV candidates stand on Medicaid expansion? #SaveACA” via Twitter @kirstinalv

Almost everyone covered through Ohio’s Medicaid expansion would have no other viable insurance option should the Affordable Care Act be repealed, a new study has found.

Law and public health researchers from The Ohio State University determined that 95 percent of newly enrolled beneficiaries would be without a plausible pathway to coverage. The research appears online in the American Journal of Public Health.

“Many of these people have nothing else to turn to,” said Eric Seiber, lead author and associate professor of health services management and policy in Ohio State’s College of Public Health.

“Their choice is Medicaid or medical bankruptcy.”

Ohio is one of 31 states (and Washington D.C.) to expand Medicaid eligibility as part of the Affordable Care Act. The move, which came in January 2014, made eligible those adults with incomes below 138 percent of the federal poverty level. (In 2015, that was about $16,243 earned annually for an individual.)

Prior to the ACA, Ohio generally did not grant Medicaid eligibility to childless adults unless they were pregnant or disabled. Parents qualified for Medicaid only if their family income was below 90 percent of the federal poverty level. By October of last year, enrollment under expansion in Ohio had reached about 712,000 people.

Efforts to repeal or substantially restructure the ACA reforms are under way.

Seiber and Micah Berman, assistant professor of public health and law at Ohio State’s College of Public Health and Moritz College of Law, evaluated data from 42,876 households that participated in Ohio’s 2015 Medicaid Assessment Survey. The telephone survey includes a set of questions to identify coverage immediately before Medicaid enrollment.

The new Ohio State research was driven by this question: “If the ACA is fully or partially repealed, who would lose their coverage and what would happen to them?”

The researchers found that the vast majority would find themselves without insurance in the case of a full ACA repeal.

Though 17.7 percent of survey participants had private health insurance prior to Medicaid enrollment, most had lost their jobs (and their coverage) or were ineligible for employer-sponsored group health plans at the time of enrollment. The researchers found that 4.8 percent of the new Medicaid recipients were eligible for insurance through their jobs, leaving 95.2 percent of new enrollees with no feasible alternative.

Seiber and Berman also found that a rollback would predominantly affect older, low-income whites with less than a college education.

“The impact of insurance is about a lot more than health care,” Berman said. “For people newly enrolled in Medicaid, it means that should they have a major health-related event, they can still pay for food, have stable housing, get out of debt. These are all things that make a huge difference in quality of life.”

A recent Ohio Medicaid analysis, which was conducted with help from Seiber and Berman and mentioned in the new study, found that that the expansion increased access to medical care, reduced unmet medical needs, improved self-reported health status and alleviated financial distress – all results found in other states that have expanded access to government coverage.

The new study shows that the majority of adults newly enrolled in Medicaid did not drop private insurance in favor of the government coverage, Seiber said.

“These are very low-income adults, many of whom lost their jobs and have nothing to go back to,” he said.

Said Berman, “It counters this perception that people have health insurance but then go on Medicaid to save money. That’s just not what the data show.”

That did happen, to an extent, with expansion of Medicaid coverage for children. But that was a different scenario because children’s eligibility begins at much higher family income levels than those in place for new adult enrollees, Seiber said.

Seiber and Berman said they hope the study offers some scientific data that will be useful during discussions of ACA repeal or revision and what it could mean for Americans now covered by Medicaid.

“I don’t think everyone realizes that if you repeal the ACA, that at the same time eliminates the Medicaid expansion,” Seiber said.

One potential weakness of the study is that the researchers were not able to evaluate how many people on Medicaid had the option to move to private insurance – because they were newly employed, for instance – but did not go that route. That type of analysis was not possible with the state-gathered data, Seiber said.

“While it is possible that some portion of these enrollees have since been hired by an employer that offers (insurance), it is unlikely that this would meaningfully improve the insurance outlook for this population,” he and Berman wrote.

The researchers said it’s important to consider the demographics of those covered under Medicaid expansion, including the fact that many are older and already have chronic health conditions that will become more costly and problematic without regular care.

“It’s a really broad cross section, and tends to be older and whiter and more rural than many would expect,” Seiber said.

Mental Health Matters But What Happens When You Are Waitlisted

Buckeyes form MHM for Mental Health Matters Week Photo Credit: Scott Bletzinger

Lately, you may have heard the term mental illness casually being tossed around in the media or during a conversation after a mass shooting has occurred as a way to label unfathomable behavior. Then, your mind immediately conjures up a version of who and what mental illness may look like based on this framework. Unfortunately, using mental illness in this context does more to stigmatize individuals who need and/or may seek help in order to improve their mental wellness.

The World Health Organization has defined mental wellness as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

Prevailing research states 1 in every 4 individuals suffer from a mental illness which equates to approximately 61.5 million people in the United States. Also, current research tells us that 50 percent of all chronic mental illness begins by age 14, and 75 percent of all chronic mental illness will manifest by age 24. This data provides valuable insight into when and where resources can be applied in order to help aid and create awareness at the onset of symptoms.

Although we are making strides in ensuring individuals have medical coverage to seek treatment for mental health disorders, many mental health providers are sorely underfunded, understaffed and unable to meet the demand for services without extreme wait times. Lack of access to short and long term mental health treatment can be deadly.

Recently, I had the opportunity to speak with Reed Walter and Grace Ferguson both of whom are students at Ohio State University. Collaboratively with their greek houses and other campus partners, they launched a campus wide campaign to address the wait times students currently face in seeking mental health treatment. Buckeye students maybe hit with up to a six week waiting period in order to get access to treatment.

More funding for mental wellness centers is needed, but students can’t afford to wait until more money can be allocated for these services. Students need these services now, so Buckeyes are trying to raise the funds themselves. The University has verified that all funds donated to this campaign will go directly to their Wellness Center. To learn more about the Mental Health Matters campaign and make a donation, see my interview with two leaders of this student-led initiative below. The campaign will end May 7th.

SWH: What is Mental Health Matters, and how did it come about?

Reed: Two years ago, I was at a greek diversity retreat and watched this video about Jonah Mowry. This reminded me of my own struggles in grade school and college and those of my peers. It reminded me of the struggles that had continued on through college. Shortly after, the facilitators urged us to come up with a collaborative event for the Greek Community. For me, that was Mental Health Matters week. Mental Health Matters is a student led initiative with the mission of eliminating stigma around mental health and increasing access to mental health support. The first year, it was my chapter and a few other chapters. This year, I was able to lead from my position of president of Phi Gamma Delta to bring this initiative to the greater greek student body.

Grace: Mental Health Matters week started as a way to bring together students and members of the Sorority and Fraternity community, but soon grew to something much bigger. Personally, I too often see friends and other students struggling with mental health, unable to get the support they need. In addition, I personally have struggled with mental health throughout my life. I truly understand the need for greater mental health services on campus, and want to help my campus be a better place.

SWH: As students, why did you take it upon yourselves to help raise funds for the Student Wellness Center?

Reed: There is a spectrum of mental health care concerns ranging from “wellness” concerns to diagnosable concerns, to emergency concerns. In my quest to find a benefactor for fundraising for the week, I found that part of the problem in the mental health industry is that many of the issues students face could be addressed with less educated individuals than a full on counselor. The Student Wellness Center hopes to provide mental health support for students before their problems get to the point of needing full on services at Counseling and Consultation Services. SWC certifies students as peer to peer wellness coaches. These wellness coaches are often able to provide substantial mental health support to students and decrease the burden on CCS, ultimately lowering the wait times for students seeking help. The wellness coaching program at OSU is one of the first of its kind. over 90 institutions are on a list serve curated by our center to learn how to set up their own programs. We are privileged to have this new type of experimental support available and want to work to ensure that it is nurtured in these early stages.

SWH: What has been the reception of Mental Health Matters Week on campus, and how could Mental Health Matters help to inspire students on other college campuses?

Reed: I think that our movement is powerful because it has sparked literally thousands of conversations on campus about mental health. Beyond reducing stigma, through these conversations new ways of advocating for mental health and increasing resources for mental health have been able to be brought to the attention of administrators on campus. For example, today, I helped pass Resolution 49-R-XX through the undergraduate student government. This resolution formalizes the fact that the entire student body supports increasing mental health care support. These larger conversations are usually only had when their is a buzz around a topic on campus. The creativity of students is limitless, I think that every college would benefit from having a week focused on starting mental health conversations. I would be happy to talk to any students or administrators about setting up their own Mental Health Matters week.

Grace: Mental Health Matters has been incredibly well received on campus, especially amongst Greek Students at Ohio State. This student-led campaign should inspire other campuses to identify areas that need support and work to fix them. Student Organizations should know that they have an entire group of eager, willing students, ready to help. Here at Ohio State we have 5,000 members of the Greek Community willing to volunteer their time and energy. By focusing in on a unique group of students and inspiring them, driven student leaders can activate an entire campus.

SWH: How can individuals and organizations support this campaign?

Reed: Individuals and organizations can help by sharing the #MHM message as far and as wide as possible. Only through sparking conversations can we help to address the stigma that is so damaging to our lives. As I mentioned before, part of that message is increasing access to mental health. The Student Wellness Center is a leader in a new type of mental health support. By sharing the work they are doing and helping to financially support it, we are able to nurture this program and allow other institutions to learn from that growth. Reducing stigma and increasing accessibility to mental health support is the most important thing that anyone can do with regards to the mental health community. By being courageous and answering the call to action by standing up to stigma, we are chipping away at the barriers to seek help. This is how we see real change in the world happen, this is how we see suicide rates drop and this is how we see our loved ones heal. Throw those in need a reason to reach out to you by sharing this message.

Grace:  A major part of Mental Health Matters Week is reducing the stigma associated with mental illness. By simply educating ourselves on mental health, the effects associated with mental illness, and viable treatment options, we can change the attitude regarding mental health on college campuses. Organizations should continue to push educational efforts and individuals should embrace these wholeheartedly.

SWH: How do you hope to improve outcomes for students needing mental health services at Ohio State University?

Grace: Primarily, I want to reduce the stigma regarding mental health. Students should be open to discussing their problems, and be able to find the help they deserve. I hope that Mental Health Matters week educates students on the existing services on campus and lets students know that help is available on campus. Second, I want to expand the available counseling services to eliminate wait times, expand locations and available times. The Student Wellness Center provides amazing services for students, but with additional funding, these services can be even better.

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