In a new paper at Medical Care Research and Review, Li et al look at service use by individuals whose insurance is regulated by the Affordable Care Act. They split the analysis into individual market enrollees with Cost Sharing Reduction subsidies (CSR), individual market enrollees without CSR, and small group market enrollees. CSR helps lower income (100-250% Federal Poverty Level (~$15-36K in 2024 for a single individual) enrollees reduce their cost sharing by lower deductibles, co-pays, coinsurance and out of pocket limits. They find some disparities and variation among service category and type of enrollee on how much spending dropped in 2020 and the 2021 rebound. That is expected.
However one figure leapt out at me. They look at professional claims that are served by telehealth. Pre-pandemic, this is low for all types of claims. It spikes for all types of claims immediately in Spring 2020. And then for physical health services, it declines again. However, telehealth for mental health spiked to 80% of all visits in that modality and a year later 60% of all mental health visits were still telehealth.
This was fascinating to me. We know that we have a mental health access problem in this country. Telehealth may modestly reduce the matching and search problems especially when folks in specific need subgroups are looking for identity concordant or affirming therapists. It makes some visits less costly as a patient can block out an hour on their calendar on Tuesday afternoon to go online instead of needing to leave work early, drive forty minutes, find parking, go to the session and then drive another hour home. But it does not magically create new capacity. If anything telehealth likely takes some capacity out of the system as cancellations are less likely.
Figuring out how to add capacity while maintaining an easy to access modality will be a big challenge.
