Health Policy Analysis

Ty Herring

Samford University

MHCA619.WB1

Dr. Haun

April 21, 2022

Health Policy Analysis

Research reveals that about 56% of Americans who seek mental health services cannot access them (Pabayo et al., 2021). The greatest barrier to access to mental health care is the increased cost of mental health services (Rowan et al., 2013). According to the author, individuals with mental illnesses have lesser chances of having health insurance compared to their counterparts without mental illnesses. On the same note, Coombs et al. (2021) urge that most Americans lack access to mental healthcare due to a lack of financial or physical resources to receive these services. People who have access to adequate healthcare are better positioned to take charge of their health, which has a positive long-term impact on their well-being. Therefore, this paper aims to provide an appropriate solution to the issue of lack of access to mental healthcare services.

Research reveals that health laws and policies strive to change the status quo by moving resources and enforcing particular behaviors to address the underlying health conditions (Heboyan et al., 2021). Mental health insurance laws are designed to enhance access to required treatment and avoid discrimination in insurance coverage by guaranteeing equitable coverage for mental health treatment and other medical disorders. Heboyan et al. (2021) further add that families with private health insurance but lack comprehensive mental health coverage face a heavy financial burden due to a lack of mental health parity. This issue has been dealt with in the past by adopting parity laws at state and federal levels. According to Heboyan et al. (2021), this legislation improves insurance coverage for mental health treatment.

There are various major laws, regulations, and policies in US healthcare. One of these is the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA aims to protect confidential patient healthcare data by explaining how healthcare providers can store, utilize, and disseminate patients’ healthcare information. Another regulation is the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH Act requires that healthcare providers’ audits comply with HIPAA security and privacy requirements to promote patient information protection. Another law in the US healthcare policy environment is the Emergency Medical Treatment and Labor Act (EMTALA). This federal law mandates that healthcare organizations provide treatment and stabilization for all people who visit the emergency department, notwithstanding their capability to pay or their insurance status. One health policy in the US is Medicare. This is a federal health care program that covers people 65 and older or under 65 with a disability, regardless of their income (Huffman & Upchurch, 2018). Medicaid is another health policy in the US. Medicaid is a federal and state program that provides health coverage to low-income earners (Buchmueller et al., 2015). Among the beneficiaries of Medicaid include temporarily unemployed workers, expectant mothers, and people with disability. The children’s Health Insurance Program (CHIP) is another health policy in the US. CHIP is intended to provide health coverage to children from low-income households. Another health policy in the US is the Affordable Care Act. Preside Barack Obama sanctioned the ACA in 2010. The Act mandates US citizens to apply for health insurance coverage and levies a penalty for people who fail to while granting exceptions for certain protected groups. Since the selected policy issue in the United States is lack of access and coverage of mental healthcare, the proposed solution for this policy issue is an expansion of Medicaid. Increasing availability of insurance coverage could improve access to mental healthcare for low-income populations.

Medicaid is the main source of health coverage in the US and is by far the biggest single-payer for mental healthcare services in the US. In 2010, roughly 33% of the Medicaid-eligible individuals experienced a mental illness in the past year, and 11% had a significant mental illness (Rowan et al., 2013). As of January 2017, seventy-seven million people were covered by Medicaid (Mazurenko et al., 2018). ACA permitted American states to expand Medicaid eligibility for nonelderly people with earnings up to 138 percent of the federal poverty line. Even though the expansion was initially supposed to be implemented throughout the nation, the US Supreme Court in 2012 declared that states may opt-out of the expansion. A total of 32 states and the District of Columbia had opted to expand Medicaid eligibility as of 2017 (Mazurenko et al., 2018). The expansion of the Medicaid led to improved access of mental health care services. However, Medicaid coverage gap has been witnessed in the US. For instance, in 2019, 2.2M uninsured persons with earnings below the poverty line were left without a road to coverage since their states failed to expand Medicaid (Sullivan et al., 2021). Thus

According to Sullivan et al. (2021), one of the critical steps toward resolving the health crisis in the US is closing the Medicaid coverage gap. This is because Medicaid eligibility protects low-income persons and those with disabilities from financial barriers to health care. So far, research reveals that Medicaid expansion by ACA has led to an increment in treatment utilization among people with mental health issues (Novak et al., 2018). On the same note, Coombs et al. (2021) urge that Medicaid expansion led to remarkable improvements in healthcare access levels, with states that expanded their Medicaid reporting reduced out-of-pocket expenditure, higher rate of use of healthcare services, and fewer skipped medications. Rowan et al. (2013) reveal that insured people with mental health issues are more likely to utilize the health care sector, while those without insurance have higher chances of using human services or complementary medicine. Rowan et al. (2013) further add that the uninsured and those with public insurance had the lowest rates of mental health treatment for individuals with serious mental illness than those with private insurance. Therefore, based on these facts, it is evident that further expansion of Medicaid will serve as a suitable solution for the chosen policy issue, which is the lack of access and coverage of mental healthcare among Americans.

To ensure that the proposed solution is implemented, I will follow all the stages of the healthcare policy-making process. The process of healthcare policy-making comprises issue identification, policy formulation, selection, advocacy, adoption, implementation, evaluation, and reformulation. The first step in healthcare policy-making is agenda-setting. This stage entails the identification of the public problem. So far, this stage has already been completed where the public problem is the lack of mental healthcare access and coverage. The second step in the healthcare policy-making process is policy formulation. After the public problem is identified, a policy is formulated to help deal with the issue affecting the general population. This stage entails defining the policy objectives. So far, I have identified various barriers to mental health care access. Among the identified barriers are high mental health services costs, lack of insurance coverage, lack of awareness, limited options, long waits, and a sense of social shame. From this list, the high cost of mental healthcare services is the main barrier to access to mental healthcare among Americans. Thus, the main objective of my policy is to improve access to mental healthcare services by removing the financial barriers to access to mental healthcare services. The third stage in the healthcare policy-making process is policy adoption. This stage involves confirming the most appropriate policy to deal with the identified public problem. Expanding Medicaid has proven to increase access to healthcare services among people suffering from mental illnesses; thus, this is the most appropriate policy to be formulated. The third stage in the healthcare policy-making process is policy implementation. After identifying the best policy to address the chosen policy issue, the next step is to implement it. The implementation phase involves representing the conversion of new programs and laws into practice. During the implementation stage of my policy, I will involve various stakeholders, including consumer groups, mental health workers, government agencies, and academic institutions. The consumer group will comprise individuals who will speak on behalf of their own healthcare treatments. The mental health workers will be recruited from both general health and mental health facilities to share their knowledge about mental health and their services. Furthermore, government agencies will be engaged in the implementation stage to help with policy implementation. The academic institutions will be involved create awareness about the implemented policy. The fourth stage in the healthcare policy-making process is policy monitoring and evaluation. This phase entails measuring whether policy outcome to determine whether or not the intended goal has been achieved. This stage also entails an evaluation of the long-term effects of the policy leading to policy redesign or amendment. The policy-making cycle is summarized below.

Figure SEQ Figure * ARABIC 1: Policy-making cycle

Source: (Knill & Tosun, (2008).

References

Buchmueller, T., Ham, J. C., & Shore-Sheppard, L. D. (2015). The Medicaid program. Economics of Means-Tested Transfer Programs in the United States, Volume 1, 21-136.

Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R. (2021). Barriers to healthcare access among US adults with mental health challenges: A population-based study. SSM-Population Health, 15, 100847. https://dx.doi.org/10.1016%2Fj.ssmph.2021.100847Haddad, C. R., Nakić, V., Bergek, A., & Hellsmark, H. (2022). Transformative innovation policy: A systematic review. Environmental Innovation and Societal Transitions, 43, 14-40. https://doi.org/10.1016/j.eist.2022.03.002Heboyan, V., Douglas, M. D., McGregor, B., & Benevides, T. W. (2021). Impact of Mental Health Insurance Legislation on Mental Health Treatment in a Longitudinal Sample of Adolescents. Medical care, 59(10), 939. https://dx.doi.org/10.1097/MLR.0000000000001619Huffman, K. F., & Upchurch, G. (2018). The health of older Americans: a primer on Medicare and a local perspective. Journal of the American Geriatrics Society, 66(1), 25-32. https://doi.org/10.1111/jgs.15227Knill, C., & Tosun, J. (2008). Policymaking.

Mazurenko, O., Balio, C. P., Agarwal, R., Carroll, A. E., & Menachemi, N. (2018). The effects of Medicaid expansion under the ACA: a systematic review. Health Affairs, 37(6), 944-950. https://doi.org/10.1377/hlthaff.2017.1491Novak, P., Anderson, A. C., & Chen, J. (2018). Changes in health insurance coverage and barriers to health care access among individuals with serious psychological distress following the Affordable Care Act. Administration and Policy in Mental Health and Mental Health Services Research, 45(6), 924-932. https://dx.doi.org/10.1007%2Fs10488-018-0875-9Pabayo, R., Benny, C., Liu, S. Y., Grinshteyn, E., & Muennig, P. (2021). Financial Barriers to Mental Healthcare Services and Depressive Symptoms among Residents of Washington Heights, New York City. Hispanic Health Care International, 15404153211057563. https://doi.org/10.1177%2F15404153211057563Rowan, K., McAlpine, D. D., & Blewett, L. A. (2013). Access and cost barriers to mental health care, by insurance status, 1999–2010. Health Affairs, 32(10), 1723-1730. https://dx.doi.org/10.1377%2Fhlthaff.2013.0133Sullivan, J., Pearsall, M., & Bailey, A. (2021). To Improve Behavioral Health, Start by Closing the Medicaid Coverage Gap. Retrieved 21 April 2022, from https://www.cbpp.org/research/health/to-improve-behavioral-health-start-by-closing-the-medicaid-coverage-gap.