Term of Award

Spring 2025

Degree Name

Master of Arts, Social Science

Document Type and Release Option

Thesis (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Department

Department of Sociology and Anthropology

Committee Chair

Alicia Brunson

Committee Member 1

Marieke Van Willigen

Committee Member 2

April Schueths

Abstract

The Affordable Care Act significantly transformed the for-profit congregate care (FPCC) industry, which provides residential treatment for adolescents with behavioral and mental health issues. This study analyzes financial records from Universal Health Services (UHS), the largest provider in the industry, to examine how healthcare policy changes and economic conditions affected the industry's growth and funding structure. Through analysis of SEC Form 10-K filings from 2006-2016, the research documents how the ACA's mental health coverage mandates created new revenue streams that enabled dramatic industry expansion. Findings show that following ACA passage in 2010, UHS more than doubled its behavioral health capacity (104.5% increase) and revenue (112.5% increase) primarily through acquisitions. The research demonstrates how the industry shifted from primarily serving affluent families through private payment to accessing public funding, while continuing to operate under minimal regulatory oversight. This "democratization" of institutional placement has extended services to previously underserved populations, including children from working-class families, foster care, and juvenile justice systems. However, without corresponding increases in transparency or accountability, this expansion raises serious concerns about whether expanded access to behavioral healthcare has resulted in improved outcomes or merely increased institutional profits.

OCLC Number

1520499775

Research Data and Supplementary Material

No

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