March 22, 2019
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Health care expansion can make the difference for Mainers suffering from depression

Troy R. Bennett | BDN
Troy R. Bennett | BDN
Young demonstrators hold signs at a rally and lobby day organized by the Maine Peoples Alliance at the State House in Augusta Wednesday, Jan. 8, around the issue of Medicaid expansion.

We join with our colleagues in the Maine Psychological Association in urging our legislators to accept federal funding to expand health care coverage for 70,000 additional Mainers.

In our clinical practices, we see firsthand the harm done by lack of insurance. People who have not been able to afford health insurance for themselves and their families often cannot afford mental health or other medical care. They don’t seek preventive care, can’t afford needed medications and don’t have access even to necessary surgeries. As a result, their medical and mental health conditions worsen, and they often turn to the one place that cannot turn them away — the hospital emergency department — but they do not receive follow-up care. This leads to poor medical and mental health outcomes, increased insurance and tax costs for all Mainers and a workforce that is plagued with health problems. When those without insurance face catastrophic medical emergencies, they can lose their homes.

The benefits of early mental health treatment are well known. Several recent studies have found that early mental health treatments both reduce overall medical expenses and increase access to appropriate services and care for those in need.

A recent study published in the Quarterly Journal of Economics examined the impact of a previous expansion of health care coverage in Oregon. This well-designed and sophisticated study compared low-income adults who were uninsured with those who gained Medicaid coverage with the expansion. Some findings of this important study are as follows: People with Medicaid coverage were more likely to report themselves in good to excellent health, rather than fair or poor health. They were more likely to use preventive care. Their likelihood of screening positive for depression was reduced by 10 percent, and the likelihood of observed depression was reduced by 30 percent.

Predictions specific to the state of Maine based on the Oregon expansion found that as many as 953 Mainers will be spared catastrophic health care expenditures in the first year of expanded coverage, 3,137 fewer Mainers will experience depression, and the lives of 157 Mainers will be saved.

While we can easily understand the importance of saving lives and preventing financial crises that devastate families, it may be more difficult to conceptualize the impact of saving 3,137 Mainers from depression.

Clinical depression, as many people know, is a disabling illness characterized by a variety of serious symptoms. People who are depressed tend to avoid social activities, have difficulty with relationships, experience changes in their work habits, struggle with parenting and feel overwhelmed by daily activities. Depression is both a biological and psychological response to a variety of factors, including ongoing environmental stress. Often depression can be avoided with early mental health treatment.

Much research has focused on the economic impact of depression. A World Health Organization study, which included nearly 250,000 people from 60 countries, compared the impact of depression to that of other chronic illnesses (arthritis, asthma and diabetes, for example), and cited depression as the second greatest cause of disability in the world. Other research examining the impact of illness, worldwide, found that lost work days were greater with depression than with other chronic illnesses such as heart disease, back pain, high blood pressure and diabetes.

Repeated absenteeism and use of sick days are only one impact of depression on the workplace; others include decreased quality of work, poor judgment and decision making, increased work-related accidents, and increased health-care costs for employers.

In other life areas, we know that depression can lead to social and family withdrawal and parental neglect, and that children of depressed parents are more likely to experience depression themselves. Depression during pregnancy can result in lower birth weights and increased incidents of pre-term labor. Depression relates to increases in alcohol and drug use, illness, chronic pain, relationship and marital problems, hospitalization, and suicide risk.

In considering the potential impact of depression cited above, the significance of preventing depression in 3,137 Mainers is astounding.

Accepting federal funds to expand health care in Maine is not only a matter of conscience; it is also one of social and economic necessity.

We strongly urge our Maine legislators to support the health care expansion.

Lenore M. Tipping and Lucy G. Quimby are psychologists in private practice in the Bangor area.


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