Essays examining the effects of parity and prescription drug policies on individuals with mental health and substance use disorders

The implementation of the Patient Protection and Affordable Care Act (ACA) is reshaping healthcare in the United States. Four central objectives of the ACA are to improve healthcare access, improve the quality of healthcare, lower the cost of healthcare, and put in place consumer protections to ensure individuals can obtain affordable care regardless of their medical history [1]. This dissertation will focus on understanding two pieces of the ACA aimed at improving access to care for individuals with mental health and/or substance use disorders (MHSUD): 1) Expanding parity of benefits between general medical care and coverage for substance use disorders (SUD) and 2) Requiring Medicaid to provide coverage for benzodiazepines, a widely prescribed psychoactive drug.;This research evaluates two previous pieces of legislation to investigate the impact of the new ACA laws. First, new parity regulations in the ACA build upon the Mental Health Parity and Addiction Equity Act (MHPAEA) implemented in 2010, the first piece of federal legislation that expanded parity of health benefits to treatment for SUDs. Understanding the impact of the MHPAEA on SUD treatment uptake provides insight into the anticipated effects of parity expansion under the ACA. Second, in 2006 TennCare, Tennessee's Medicaid program, discontinued coverage for benzodiazepines (BNZ) for Medicaid recipients ages 21 and older. The sudden policy change makes it possible to evaluate the consequences and potential benefits of altering coverage for a widely used prescription medication that carries a high risk for abuse or dependence.;[1] "Key Features of the Affordable Care Act." HHS.gov/HealthCare. US Department of Health and Human Services. http://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca/index.html. (Accessed Feb 15, 2014).