Elsewhere in this issue, Garfield et al. (1) note that, in the United States today, adults with mental disorders are less likely to be insured than are adults in the population at large. They also review reports showing that rates of use of mental health services by individuals with mental disorders requiring treatment are much higher for those with insurance than for those without insurance (one in five receiving services versus one in two receiving services, respectively, during a recent 3-year period). The contribution of Garfield and colleagues is projection of the volume of increased use in mental health services with the advent of insurance reform, given that many individuals with mental illnesses who currently are uninsured will become insured. Among individuals with more severe mental illnesses, they predict that nearly 3.7 million will gain coverage under insurance reform. Considering less debilitating forms of mental illness, they predict an additional 27.6 million will gain coverage. While not everyone in need of services who is newly insured will seek services, many will. One can question the various cutoffs and assumptions that went into the models used by Garfield et al. (concerning the number of people who will seek services, etc.), but the bottom line is clear: insurance reform will have the desired consequence of opening treatment to huge numbers of needy individuals, and individuals with more severe mental illnesses, because they will have been more likely to have been uninsured, will represent a disproportionately large amount of the increased demand for services, especially among newly insured individuals covered by Medicaid. This means that market forces are about to shift dramatically, and managed care entities, including state Medicaid offices, are about to face huge payment challenges and strategic opportunities.