Unemployment Insurance, Health-Related Social Needs, Health Care Access, and Mental Health During the COVID-19 Pandemic.
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ABSTRACT:
SUBMITTER: Berkowitz SA
PROVIDER: S-EPMC8094006 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
Publications
Unemployment Insurance, Health-Related Social Needs, Health Care Access, and Mental Health During the COVID-19 Pandemic.
Berkowitz Seth A SA Basu Sanjay S
JAMA internal medicine 20210501 5
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Project description:Federal Pandemic Unemployment Compensation (FPUC) provided unemployment insurance beneficiaries an extra $600 a week during the unprecedented economic downturn during the coronavirus disease 2019 (COVID-19) pandemic, but it initially expired in July 2020. We applied difference-in-differences models to nationally representative data from the Census Bureau's Household Pulse Survey to examine changes in unmet health-related social needs and mental health among unemployment insurance beneficiaries before and after initial expiration of FPUC. The initial expiration was associated with a 10.79-percentage-point increase in risk for self-reported missed housing payments. Further, risk for food insufficiency, depressive symptoms, and anxiety symptoms also increased among households that reported receiving unemployment insurance benefits, relative to the period when FPUC was in effect. As further unemployment insurance reform is debated, policy makers should recognize the potential health impact of unemployment insurance.
| S-EPMC8053426 | biostudies-literature
Project description:Research demonstrates that receiving unemployment insurance decreases mental health problems. But researchers have also found racial and ethnic disparities in unemployment insurance receipt resulting from differences in work history and location. We examined a population disproportionately affected by job loss and unemployment insurance exclusions, using a survey of service workers from a single city who were parents of young children and who overwhelmingly had eligible work histories. During the COVID-19 pandemic, workers not identifying as White non-Hispanic in our sample were more likely to get laid off than White workers. Among those who were laid off, these workers and White workers experienced similar increases in material and mental health difficulties and similar gains when they received unemployment insurance. However, these workers were less likely than White workers to receive unemployment insurance at all. These results indicate that unemployment insurance has unrealized potential to reduce material and health disparities. Policies should be implemented to make this coverage more effective and equitable through increased access.
| S-EPMC10353345 | biostudies-literature
Project description:ImportanceMany US children and adolescents with mental and behavioral health (MBH) conditions do not access MBH services. One contributing factor is limited insurance coverage, which is influenced by state MBH insurance parity legislation.ObjectiveTo investigate the association of patient-level factors and the comprehensiveness of state MBH insurance legislation with perceived poor access to MBH care and perceived inadequate MBH insurance coverage for US children and adolescents.Design, setting, and participantsThis retrospective cross-sectional study was conducted using responses by caregivers of children and adolescents aged 6 to 17 years with MBH conditions in the National Survey of Children's Health and State Mental Health Insurance Laws Dataset from 2016 to 2019. Data analyses were conducted from May 2022 to January 2024.ExposureMBH insurance legislation comprehensiveness defined by State Mental Health Insurance Laws Dataset (SMHILD) scores (range, 0-7).Main outcomes and measuresPerceived poor access to MBH care and perceived inadequacy of MBH insurance were assessed. Multivariable regression models adjusted for individual-level characteristics.ResultsThere were 29 876 caregivers of children and adolescents with MBH conditions during the study period representing 14 292 300 youths nationally (7 816 727 aged 12-17 years [54.7%]; 8 455 171 male [59.2%]; 292 543 Asian [2.0%], 2 076 442 Black [14.5%], and 9 942 088 White [69.6%%]; 3 202 525 Hispanic [22.4%]). A total of 3193 caregivers representing 1 770 492 children and adolescents (12.4%) perceived poor access to MBH care, and 3517 caregivers representing 1 643 260 of 13 175 295 children and adolescents (12.5%) perceived inadequate MBH insurance coverage. In multivariable models, there were higher odds of perceived poor access to MBH care among caregivers of Black (adjusted odds ratio [aOR], 1.35; 95% CI, 1.04-1.75) and Asian (aOR, 1.69; 95% CI, 1.01-2.84) compared with White children and adolescents. As exposures to adverse childhood experiences (ACEs) increased, the odds of perceived poor access to MBH care increased (aORs ranged from 1.68; 95%, CI 1.32-2.13 for 1 ACE to 4.28; 95% CI, 3.17-5.77 for ≥4 ACEs compared with no ACEs). Compared with living in states with the least comprehensive MBH insurance legislation (SMHILD score, 0-2), living in states with the most comprehensive legislation (SMHILD score, 5-7) was associated with lower odds of perceived poor access to MBH care (aOR, 0.79; 95% CI, 0.63-0.99), while living in states with moderately comprehensive legislation (score, 4) was associated with higher odds of perceived inadequate MBH insurance coverage (aOR, 1.23; 95% CI, 1.01-1.49).Conclusions and relevanceIn this study, living in states with the most comprehensive MBH insurance legislation was associated with lower odds of perceived poor access to MBH care among caregivers for children and adolescents with MBH conditions. This finding suggests that advocacy for comprehensive mental health parity legislation may promote improved child and adolescent access to MBH services.
| S-EPMC11320173 | biostudies-literature
Project description:The cost of mental health services has always been a great barrier to accessing care for people with mental health problems. This article documents changes in insurance coverage and cost for mental health services for people with public insurance, private insurance, and no coverage. In 2009-10 people with mental health problems were more likely to have public insurance and less likely to have private insurance than in 1999-2000. Although access to specialty care remained relatively stable for people with mental illnesses, cost barriers to care increased among the uninsured and the privately insured who had serious mental illnesses. The rise in cost barriers among those with private insurance suggests that the current financing of care in the private insurance market is insufficient to alleviate cost burdens and has implications for reforms under the Affordable Care Act. People with mental health problems who are newly eligible to purchase private insurance under the act might still encounter high cost barriers to accessing care.
| S-EPMC4236908 | biostudies-literature
Project description:ObjectiveTo evaluate whether reported prevalence of unemployment, subsistence needs, and symptoms of depression and anxiety among adults with diagnosed HIV during the COVID-19 pandemic were higher than expected.DesignThe Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States.MethodsWe analyzed 2015-2019 MMP data using linear regression models to calculate expected prevalence, along with corresponding prediction intervals (PI), for unemployment, subsistence needs, depression, and anxiety for June-November 2020. We then assessed whether observed estimates fell within the expected prediction interval for each characteristic, overall and among specific groups.ResultsOverall, the observed estimate for unemployment was higher than expected (17% vs. 12%) and exceeded the upper limit of the PI. Those living in households with incomes ≥400% of FPL were the only group where the observed prevalence of depression and anxiety during the COVID-19 period was higher than the PIs; in this group, the prevalence of depression was 9% compared with a predicted value of 5% (75% higher) and the prevalence of anxiety was 11% compared with a predicted value 5% (137% higher). We did not see elevated levels of subsistence needs, although needs were higher among Black and Hispanic compared with White persons.ConclusionsEfforts to deliver enhanced employment assistance to persons with HIV and provide screening and access to mental health services among higher income persons may be needed to mitigate the negative effects of the US COVID-19 pandemic.
| S-EPMC11299507 | biostudies-literature
Project description:We use micro data on earnings together with the details of each state's unemployment insurance (UI) system to compute the distribution of UI benefits after the uniform $600 Federal Pandemic Unemployment Compensation (FPUC) supplement implemented by the CARES Act. We find that between April and July 2020, 76% of workers eligible for regular Unemployment Compensation have statutory replacement rates above 100%, meaning that they are eligible for benefits which exceed lost wages. The median statutory replacement rate is 145%. We also compute comprehensive replacement rates, which account for employer provided non-wage compensation and differential tax treatment of labor income and UI. 69% of UI-eligible unemployed have comprehensive replacement rates above 100% and the median comprehensive replacement rate is 134%. The presence of the FPUC has important implications for the incidence of the recession and reverses income patterns which would have otherwise arisen across income levels, occupations, and industries.
| S-EPMC7525248 | biostudies-literature
Project description:ImportanceThe COVID-19 pandemic has been associated with increased unemployment rates and long periods when individuals were without health insurance. Little is known about how Medicaid expansion facilitates Medicaid enrollment as a buffer to coverage loss owing to unemployment.ObjectiveTo compare changes in health insurance coverage status associated with pandemic-related unemployment among previously employed adults in states that have vs have not expanded Medicaid eligibility.Design setting and participantsThis cohort study included US adults aged 27 to 64 years who were employed at baseline in the 2020 to 2021 Current Population Survey's Annual Social and Economic Supplement, which included calendar years 2019 to 2020 (32 462 person-years). Data analyses were conducted between November 2021 and April 2022.ExposuresJob loss (ie, new unemployment) experienced during 2020.Main outcomes and measuresPrimary outcomes were coverage status (ie, uninsured status) and source of coverage (ie, employer sponsored, marketplace, and Medicaid). Using 2-way person-by-year fixed-effects regression models, changes in coverage status associated with unemployment in states that expanded Medicaid were compared with states that did not expand Medicaid. Additional analyses were performed based on prepandemic coverage status.ResultsThe cohort included 16 231 adults (mean age, 46.8 [95% CI, 46.6-47.0] years; 51.6% women). New unemployment was associated with an increase of 2.9 (95% CI, 1.1-4.6) percentage points (P = .002) in the proportion of uninsured adults in Medicaid expansion states and an increase of 10.7 (95% CI, 2.4-18.9) percentage points (P = .01) in nonexpansion states. Workers were 5.4 (95% CI, 1.9-8.9) percentage points (P = .003) more likely to enroll in Medicaid after a job loss if they lived in a Medicaid expansion state compared with workers experiencing job loss in nonexpansion states.Conclusions and relevanceIn this cohort study of US adults, unemployment-related Medicaid enrollment was more frequent in Medicaid expansion states during the COVID-19 pandemic. Medicaid expansion led to a smaller increase in uninsured adults because those who lost private insurance coverage (eg, employer sponsored) appeared more able to transition to Medicaid after job loss.
| S-EPMC9206185 | biostudies-literature
Project description:ObjectiveTo provide new evidence on the effects of large-scale public health insurance expansions, associated with the Affordable Care Act (ACA), on the availability of specialty mental health care treatment in the United States. We measure availability with the probability that a provider accepts Medicaid.Data source/study settingThe National Mental Health Services Survey (N-MHSS) 2010-2018.Study designA quasi-experimental differences-in-differences design using observational data.Data collectionThe N-MHSS provides administrative data on the universe of specialty mental health care providers in the United States. Response rates are above 90 percent in all years. Data cover 85 019 provider/year observations.Principal findingsACA-Medicaid expansion increases the probability that a provider accepts Medicaid by 1.69 percentage points, 95 percent confidence interval: [0.0017,0.0321], which corresponds to an increase from 87.27 percent pre-expansion to 90.27 percent postexpansion in expansion states or a 1.94 percent increase. We observe spillovers to Medicare, although this finding is sensitive to specification.ConclusionsThis study provides evidence on the impact of ACA-Medicaid expansion on accepted forms of payment for specialty mental health care treatment. Findings suggest that expansion increases availability of providers who deliver valuable care for enrollees with severe mental illness. These findings may help policy makers reflecting on the future directions of the US health care delivery system.
| S-EPMC7375998 | biostudies-literature
Project description: Not available
| S-EPMC9486636 | biostudies-literature
Project description:PurposeSubjective social status (SSS) reflects individuals' perceived position in a social hierarchy. Low SSS is associated with several mental health impairments. The aim of this cross-sectional study was to examine if unemployed individuals report lower SSS in Germany (national SSS) and lower SSS in their social community (local SSS) than employed individuals. Moreover, the relationship between unemployment, SSS, and mental health was examined.Patients and methods113 unemployed and 1117 employed individuals from a representative German panel provided information on their national and local SSS, their monthly income and their mental health. SSS was assessed with the German version of the MacArthur Scales. Mental health was measured using the mental component scale (MCS) of the SF-12.ResultsUnemployed individuals reported significantly lower national SSS, local SSS and mental health compared to employed participants. Mediational analyses suggest that the negative effect of employment status on mental health was explained via a reduction of national SSS. Local SSS did not mediate the association of employment status and mental health.ConclusionUnemployment is associated with lower SSS and reduced mental health. The perceived position relative to others in the country (ie, national SSS) mediates the association between employment status and mental health.
| S-EPMC6664150 | biostudies-literature