The politics of Obamacare have produced a geographic divide in mental health care. Uninsured, low-income Americans in the east, mid-Atlantic and Pacific are receiving more treatment through the Medicaid expansion, while those in the south and central U.S. are not, according to a new report.

Nearly 568,000 uninsured people who have been diagnosed with a serious mental health condition would have received treatment in 2014 if their states had chosen to expand Medicaid, according to the American Mental Health Counselors Association, a professional organization that does advocacy and education. That’s one in five of the nearly 3 million uninsured adults with serious mental health conditions who live in the 24 states that did not expand Medicaid last year. That treatment would have been fully paid for by the federal government.

Obamacare extended Medicaid to anyone whose income is below 138 percent of the federal poverty line ($15,521 for an individual last year), with the federal government paying 100 percent of the cost of insuring new enrollees for three years. But after a 2012 Supreme Court ruling gave states the option of not expanding Medicaid eligibility, some states elected to continue receiving “traditional” Medicaid, rather than accept the expanded funds. In 2014, 24 states went this route. The report accuses those states of rejecting Medicaid coverage “based on ideological intransigence – not health or fiscal interests.”

The map below shows the number of uninsured people between the ages of 18 and 64 that did or would have received affordable treatment for a serious mental health disorder in 2014, according to AMHCA estimates.


The grey states have accepted the expanded Medicaid funds, so the numbers there represent the estimated number of mentally ill patients that were treated. An estimated 350,000 people with mental illness received treatment for their conditions, including prescription drugs and regular health visits in 26 states and D.C., which did expand Medicaid in 2014.

The green states opted out of the Medicaid expansion, meaning the numbers represent the patients that would have been treated, but weren’t. As the map shows, an estimated 66,723 patients in Florida and 62,400 patients in Texas would have received treatment in 2014. The numbers are also large in Indiana and Pennsylvania, two states that elected to expand Medicaid eligibility in 2015.

People who don’t get treatment for mental illness can end up in jail or homeless; past research has found that about 30 percent of the chronically homeless in the U.S. are mentally ill. They are also more likely to fail out of school, lose their jobs or end up in the emergency room. And lack of treatment leads to more hospitalizations, suicides and suffering for the mentally ill and their families.

Many of these beneficiaries are young adults between the age of 18 and 34. Some are veterans: Roughly 175,000 uninsured veterans with mental illness live below the federal poverty line, the report says. The expansion would also have an impact on children, the AMHCA argues, since research suggests that parents who obtain health insurance are more likely to get coverage for their children.

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