Ali Mir M, Teich Judith L, Mutter Ryan
The authors are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland (e-mail:
Psychiatr Serv. 2017 Jul 1;68(7):667-673. doi: 10.1176/appi.ps.201600315. Epub 2017 Apr 3.
Since full implementation of the Affordable Care Act (ACA) in 2014, the number of uninsured individuals in the United States has declined considerably; however, millions still lack health insurance. Although 29% of the remaining uninsured population (8.5 million individuals) have a mental or substance use disorder, little is known about this population.
This study used data from the 2014 National Survey on Drug Use and Health to describe demographic characteristics, socioeconomic status, and use of behavioral health services among adults (ages 18-64) with a behavioral disorder who remained uninsured (unweighted N=2,300; weighted N of approximately 8.5 million).
Over half of individuals with a behavioral disorder who remained uninsured were non-Hispanic whites. The largest age group was 26- to 35-year-olds. Most worked in clerical or blue-collar occupations, and less than 20% were college graduates and above. More than 90% could qualify for insurance assistance under the ACA, either through Medicaid eligibility (income <138% of the federal poverty level [FPL]) or eligibility for cost-sharing subsidies or tax credits on the health insurance exchanges (income ≥138% but <400% of the FPL). Rates of behavioral health treatment were low; however, nearly half of Medicaid-eligible individuals (46%) reported a past-year emergency department visit.
The high proportion of behavioral health conditions among the remaining uninsured population, and the fact that a significant portion of this population would be eligible for ACA insurance support, highlights the need for continued educational outreach efforts and steps to remove barriers to treatment access.
自2014年《平价医疗法案》（ACA）全面实施以来，美国未参保人数大幅下降；然而，仍有数百万人缺乏医疗保险。尽管剩余未参保人群中有29%（850万人）患有精神疾病或物质使用障碍，但对这一人群了解甚少。
本研究使用了2014年全国药物使用和健康调查的数据，来描述仍未参保的患有行为障碍的成年人（18 - 64岁）的人口统计学特征、社会经济地位以及行为健康服务的使用情况（未加权N = 2300；加权N约为850万）。
仍未参保的患有行为障碍的人群中，超过一半是非西班牙裔白人。最大的年龄组是26至35岁。大多数人从事文职或蓝领职业，不到20%是大学毕业生及以上学历。超过90%的人可根据《平价医疗法案》获得保险援助，要么通过医疗补助资格（收入低于联邦贫困线[FPL]的138%），要么通过符合在医疗保险交易所获得费用分摊补贴或税收抵免的资格（收入≥FPL的138%但<400%）。行为健康治疗率较低；然而，近一半符合医疗补助资格的人（46%）报告在过去一年去过急诊室。
在剩余未参保人群中行为健康状况比例较高，且这一人群中有很大一部分有资格获得《平价医疗法案》的保险支持，这凸显了持续开展教育推广工作以及采取措施消除治疗障碍的必要性。
