How mental health policy aimed at increasing access has impacted new moms

How did mental health parity laws affect new moms?

8:00 AM

Host: 

Welcome to Health Lab, your destination for news and stories about the future of health care. Today: How did mental health parity laws affect new moms? A new study finds that after two major health policy shifts aimed at increasing access to care, slightly more pregnant and postpartum women with depression or anxiety received psychotherapy.

Pregnant and postpartum women with depression and anxiety have a slightly better chance of getting psychotherapy these days, a study finds.

And they’re paying less of their own money when they do. 

The changes in care and cost happened mainly after the Affordable Care Act took effect in 2014, and to a lesser extent after the Mental Health Parity and Addiction Equity Act, or MHPAEA, took effect in 2010, the analysis shows. 

Both laws aimed at reducing insurance-related barriers to mental health care. 

Even so, only about 10% of women with private insurance who had a mental health diagnosis of anxiety or depression during pregnancy or during their postpartum year received psychotherapy in 2019 to 2020, according to the analysis. 

And with 25% of pregnant women and new mothers having at least one of these mental health diagnoses in 2019, up from 14% in 2007, that means a lot of women did not get the evidence-based care that could help both them and their babies. 

The findings from the Maternal Behavioral Health Policy Evaluation Study, often referred to as MAPLE, are published in JAMA Network Open by a University of Michigan team. 

“The gap between mental and physical health care closed slightly over time, and cost barriers decreased marginally,” said lead author Kara Zivin, Ph.D. 

But these positive trends happened slowly even after insurance laws changed, likely due to a combination of a shortage of mental health care providers, underdiagnosis of pregnancy-related mental health conditions, and stigma against seeking mental health help. 

“In this high risk population, and in the context of what we know about the impact of mental health conditions on maternal mortality, many people get missed,” said Zivin.

“Even among the 50% of women with depression and anxiety diagnoses who attended psychotherapy during this study period, individuals on average only had one visit,” she added. 

Zivin and her colleagues focused on the impact of health policy changes for women with perinatal mood and anxiety disorders. 

They used sophisticated statistical methods to examine what happened after the MHPAEA and ACA each took effect. 

Both laws included provisions designed to require insurers to cover mental health care and physical health care equally and to treat mental health as an essential benefit. 

In general, women’s chances of receiving psychotherapy began to rise after the MHPAEA and increased even more after the ACA. 

The study also shows wide variation in average out-of-pocket costs for women who received psychotherapy at least once, depending on what time of year they received it. 

Those whose appointments happened in the first months of the year paid on average more than $50 out of pocket, compared with under $25 for those who received care during the last month of 2018 and 2019. 

The analysis showed that this seasonal variation increased after the Affordable Care Act took effect. 

Society-wide increases in employer-sponsored and ACA marketplace high-deductible health plans may have contributed to the variation in out-of-pocket costs throughout a calendar year. 

Such plans require the insured person to pay the full cost of care at the start of each coverage year until they reach the amount set as their plan’s deductible. 

Zivin and her colleagues looked at data from more than 716,000 women between the ages of 15 and 44 who gave birth between the start of 2007 and the end of 2019 in the US, for a total of more than 837,000 births. 

All were continuously enrolled in a single private health insurance plan for at least a year before and after they gave birth. 

The team focused on those who had a mental health diagnosis during the two years surrounding their deliveries. 

Within this group, they looked at those who used insurance to pay for at least one psychotherapy visit with a mental health provider. 

The findings build on the team’s recently published work showing other trends in mental health diagnosis and care in the perinatal period, including increases in antidepressant treatment. 

The study doesn’t include women covered by Medicaid, who tend to have lower incomes and account for 42% of the births in the United States. 

Nor does the study include women who did not use insurance to pay for psychotherapy, for instance because they saw a mental health provider who does not accept insurance at all, or who does not participate in an insurance plan’s network. 

That kind of “private pay” situation does not appear in the data source that the team used, Optum’s deidentified Clinformatics Data Mart Database. 

Zivin notes that the data in this study come mostly from a time before the COVID-19 pandemic, when insurers began or increased coverage for tele-mental health care. 

Further research on data from 2020 onward should examine whether telehealth access increased the percentage of pregnant and postpartum women receiving psychotherapy, she says – for instance, if they live in the areas with severe shortages of mental health providers. 

Zivin also comments that insurance-related national health care laws cannot directly address the ongoing shortage of mental health providers. 

That shortage stems in part from the exact issue that mental health parity laws aim to address: decades of differences in mental health care and physical health care coverage under both private insurance and public programs such as Medicaid and Medicare. 

For more on this story and for others like it, visit michiganmedicine.org/health-lab. Health Lab is a part of the Michigan Medicine Podcast Network, and is produced by the Michigan Medicine Department of Communication. You can subscribe to Health Lab wherever you listen to podcasts.


More Articles About: anxiety Depression Mental Health health policy podcast Michigan Medicine
Health Lab Podcast in brackets with a background with a dark blue translucent layers over cells
Health Lab Podcast

Listen to more Health Lab podcasts - a part of the Michigan Medicine Podcast Network.

Featured News & Stories Health Lab Podcast in brackets with a background with a dark blue translucent layers over cells
Health Lab Podcast
Tips for Hosting Allergy-Safe Holidays
Precautions are crucial — even lifesaving — when feeding guests with dietary restrictions. Simple strategies can help avoid issues at the dinner table.
Minding Memory with a microphone and a shadow of a microphone on a blue background
Minding Memory
Can a personalized music intervention reduce behavioral disturbances in dementia?
While memory loss is generally thought of as the hallmark of dementia, behavioral and psychological symptoms of dementia like agitation, aggression, anxiety, and hallucinations are nearly universal, affecting almost all patients with advanced dementia. These behavioral disturbances are often the trigger for nursing home placement, and they can be highly distressing for both patients and their care partners. In today’s episode, Matt and Lauren speak with Dr. Ellen McCreedy, a researcher from the Brown School of Public Health who has conducted a study of personalized music intervention called Music & Memory for people living with dementia in nursing homes. Dr. McCreedy is a gerontologist and health services researcher who focuses on evaluation of non-pharmacologic interventions for managing behavioral disturbances of people living with dementia.
family of four sitting on couch in living room looking at an ipad laughing
Health Lab
Grandparents help grandkids in many ways – but the reverse may be true too
A poll shows the many ways (childcare, nutrition, major expenses) that grandparents help their grandchildren, but also suggests a link to older adults’ sense of isolation and their mental health.
Politics depression image
Health Lab
5 ways to manage politically induced stress
A Michigan Medicine psychiatrist offers strategies for how to be mindful of depression and anxiety symptoms around the topic of politics.
Minding Memory with a microphone and a shadow of a microphone on a blue background
Minding Memory
The Impact of Partner Plan Choices among Older Adults Enrolled in Medicare Advantage (MMs4)
In this episode, Matt & Lauren speak with Dr. Lianlian Lei, an Assistant Professor in the Department of Psychiatry at the University of Michigan. Dr. Lei discusses a recent study that looks at the impact of partner’s plan choice on the likelihood of Medicare Advantage disenrollment and how that may impact older adults living with dementia. Unlike traditional Medicare that's administered by the federal government, Medicare Advantage are healthcare plans that are administered by private health insurance companies. These plans can vary a lot and typically cover additional services not covered by traditional Medicare. Navigating the various plan options can be a challenge for older adults, and it's not uncommon for individuals to change plans depending on their current needs.
doctor with head and neck in hands sitting down seeming depressed or stressed
Health Lab
More research is needed to support physicians' mental health, experts say
A pair of researchers who have studied physician mental health and stress call for more efforts to supports to prevent burnout and support wellbeing.