Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care

  • Joshua BreslauEmail author
  • Bradley D. Stein
  • Hao Yu
  • Rachel M. Burns
  • Bing Han
Original Article


We examine the impact of insurance expansion under the Affordable Care Act’s Dependent Care Expansion (DCE) on allocation of mental health care across illness severity, types of care and racial/ethnic groups. Evidence suggests that the increase in mental health care utilization resulting from the DCE was restricted to individuals with clinically significant mental health conditions. There is no evidence suggesting that the increase occurred disproportionately in medication-only treatment or that it increased racial/ethnic disparities. The DCE appears to have been successful in increasing utilization of mental health care among a high need group without lowering quality or increasing disparities.


Health insurance Mental health service use Racial/ethnic disparities 



This research was supported by a Grant from the National Institute on Minority Health and Health Disparities (R01 MD010274).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Study procedures were approved by the Human Subjects Protection Committee of the RAND Corporation.


  1. Adams, A. S., Soumerai, S. B., Zhang, F., Gilden, D., Burns, M., Huskamp, H. A., … Madden, J. M. (2015). Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression. Clinical Therapeutics, 37(3), 597–609. Scholar
  2. Aldworth, J., Colpe, L. J., Gfroerer, J. C., Novak, S. P., Chromy, J. R., Barker, P. R., … Spagnola, K. (2010). The National Survey on Drug Use and Health Mental Health Surveillance Study: Calibration analysis. International Journal of Methods in Psychiatric Research, 19(Suppl 1), 61–87. Scholar
  3. Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., … Finkelstein, A. N. (2013). The Oregon experiment—Effects of medicaid on clinical outcomes. New England Journal of Medicine, 368(18), 1713–1722. doi.CrossRefGoogle Scholar
  4. Breslau, J., Han, B., Stein, B. D., Burns, R. M., & Yu, H. (2017). Did the Affordable Care Act’s dependent coverage expansion affect race/ethnic disparities in health insurance coverage? Health Services Research. Scholar
  5. Breslau, J., Lane, M., Nancy, S. B., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research, 42(9), 708–716.CrossRefGoogle Scholar
  6. Breslau, J., Miller, E., Jin, R., Sampson, N. A., Alonso, J., Andrade, L. H., … Kessler, R. C. (2011). A multinational study of mental disorders, marriage, and divorce. Acta Psychiatrica Scandinavica, 124(6), 474–486. Scholar
  7. Breslau, J., Stein, B. D., Han, B., Shelton, S., & Yu, H. (2018). Impact of the Affordable Care Act’s dependent coverage expansion on the health care and health status of young adults: What do we know so far? Medical Care Research and Review, 75, 131–152.CrossRefGoogle Scholar
  8. Center for Behavioral Health Statistics and Quality. (2016). 2014 National Survey on drug use and health: Methodological resource book (Sect. 10, Editing and Imputation Report). Rockville, MD Retrieved from
  9. Collins, S. R., Robertson, R., Garber, T., & Doty, M. M. (2012). Young, uninsured, and in debt: Why young adults lack health insurance and how the Affordable Care Act is helping: Findings from the Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011. Issue Brief (Commonw Fund), 14, 1–24.Google Scholar
  10. Colpe, L. J., Barker, P. R., Karg, R. S., Batts, K. R., Morton, K. B., Gfroerer, J. C., … Aldworth, J. (2010). The National survey on drug use and health mental health surveillance study: Calibration study design and field procedures. International Journal of Methods in Psychiatric Research, 19(Suppl 1), 36–48. Scholar
  11. Cook, B. L., Zuvekas, S. H., Carson, N., Wayne, G. F., Vesper, A., & McGuire, T. G. (2014). Assessing racial/ethnic disparities in treatment across episodes of mental health care. Health Services Research, 49(1), 206–229. Scholar
  12. DeLeire, T., Dague, L., Leininger, L., Voskuil, K., & Friedsam, D. (2013). Wisconsin experience indicates that expanding public insurance to low-income childless adults has health care impacts. Health Affairs, 32(6), 1037–1045. Scholar
  13. Druss, B. G., Wang, P. S., Sampson, N. A., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2007). Understanding mental health treatment in persons without mental diagnoses: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 64(10), 1196–1203. Scholar
  14. Gibb, S. J., Fergusson, D. M., & Horwood, L. J. (2010). Burden of psychiatric disorder in young adulthood and life outcomes at age 30. The British Journal of Psychiatry, 197(2), 122–127. Scholar
  15. Golberstein, E., Busch, S. H., Zaha, R., Greenfield, S. F., Beardslee, W. R., & Meara, E. (2015). Effect of the affordable care act’s young adult insurance expansions on hospital-based mental health care. American Journal of Psychiatry, 172(2), 182–189. Scholar
  16. Han, B., Compton, W. M., Mojtabai, R., Colpe, L., & Hughes, A. (2016). Trends in receipt of mental health treatments among adults in the United States, 2008–2013. Journal of Clinical Psychiatry, 77(10), 1365–1371. Scholar
  17. Huhn, M., Tardy, M., Spineli, L. M., Kissling, W., Förstl, H., Pitschel-Walz, G., … & Leucht, S. (2014). Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: A systematic overview of meta-analyses. JAMA Psychiatry, 71(6), 706–715. Scholar
  18. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L. T., … Zaslavsky, A. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976. Scholar
  19. Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., … Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. Scholar
  20. Kessler, R. C., & Ustun, T. B. (2004). The world mental health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121.CrossRefGoogle Scholar
  21. Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P. S., … Kessler, R. C. (2011). Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine, 41(8), 1751–1761. Scholar
  22. Novak, S. P., Colpe, L. J., Barker, P. R., & Gfroerer, J. C. (2010). Development of a brief mental health impairment scale using a nationally representative sample in the USA. International Journal of Methods in Psychiatric Research, 19(Suppl 1), 49–60. Scholar
  23. Park, M. J., Mulye, T. P., Adams, S. H., Brindis, C. D., & Irwin Jr, C. E. (2006). The health status of young adults in the United States. Journal of Adolescent Health, 39(3), 305–317. Scholar
  24. Saloner, B., & Le Cook, B. (2014). An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group. Health Affairs, 33(8), 1425–1434. Scholar
  25. Shane, D. M., Ayyagari, P., & Wehby, G. (2016). Continued gains in health insurance but few signs of increased utilization: An update on the ACA’s dependent coverage mandate. Medical Care Research and Review, 73(4), 478–492. Scholar
  26. Slusky, D. J. (2015). Significant placebo results in difference-in-differences analysis: The case of the ACA’s parental mandate. Eastern Economic Journal, 43, 1–24.Google Scholar
  27. Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The affordable care act has led to significant gains in health insurance and access to care for young adults. Health Affairs, 32(1), 165–174. Scholar
  28. Sommers, B. D., & Kronick, R. (2012). The affordable care act and insurance coverage for young adults. JAMA, 307(9), 913–914. Scholar
  29. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: Results from the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 629–640.CrossRefGoogle Scholar
  30. Yu, J. W., Adams, S. H., Burns, J., Brindis, C. D., & Irwin, C. E. Jr. (2008). Use of mental health counseling as adolescents become young adults. Journal of Adolescent Health, 43(3), 268–276. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.RAND CorporationPittsburghUSA
  2. 2.RAND CorporationSanta MonicaUSA

Personalised recommendations