Abstract
Under the dependent coverage expansion (DCE) provision of health reform adult children up to 26 years of age whose parents have employer-sponsored or individual health insurance are eligible for insurance under their parents’ health plan. Using a difference-in-differences approach and the 2008–2014 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases we examined the impact of the DCE on hospital services use. In analyses of individuals age <26 years (compared to individuals over 26) we found a 1.5% increase in non-pregnancy related inpatient visits in 2010 through 2013 during the initial DCE period and a 1.6% increase in 2014 when other state expansions went into effect. We found that the impact of the DCE persisted into 2014 when many state insurance expansions occurred, although effects varied for states adopting and not adopting Medicaid expansions.
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References
Ali MM, Chen J, Mutter R, Novak P, Mortensen K (2016) The ACA’s Dependent Coverage Expansion and Out-of-Pocket Spending by Young Adults With Behavioral Health Conditions. Psychiatr Serv 67(9):977–982
Alvarez EM, Keegan T, Johnston EE, Haile R, Sanders L, Wise P (2017) The affordable care act dependent coverage expansion (ACA-DCE): disparities in impact in young adult oncology patients. J Clin Oncol 35(15):6561
Anderson M, Dobkin C, Gross T (2012) The effect of health insurance coverage on the use of medical services. Am Econ J Econ Policy 4(1):1–27
Antwi YA, Moriya AS, Simon K (2012) Effects of federal policy to insure young adults: evidence from the 2010 Affordable Care Act dependent coverage mandate. NBER Working Paper No.18200. http://www.nber.org/papers/w18200
Antwi YA, Moriya AS, Simon K, Sommers BD (2015) Changes in emergency department use among young adults after the patient protection and affordable care act’s dependent coverage provision. Ann Emerg Med 65(6):664–672
Antwi YA, Moriya AS, Simon K (2015) Access to health insurance and the use of inpatient medical care: evidence from the affordable care act young adult mandate. J Health Econ 39(2015):171–187
Barbaresco S, Courtemanche CJ, Qi Y (2015) Impacts of the affordable care act dependent coverage provision on health-related outcomes of young adults. J Health Econ 40:54–68
Breslau J, Stein BD, Han B, Shelton S, Yu H (2018) Impact of the affordable care act’s dependent coverage expansion on the health care and health status of young adults. Med Care Res Rev 75(2):131–152
Breslau J, Han B, Stein BD, Burns RM, Yu H (2017) Did the affordable care act’s dependent coverage expansion affect race/ethnic disparities in health insurance coverage? Health Serv Res. https://doi.org/10.1111/1475-6773.12728
Busch SH, Golberstein E, Meara E (2014) ACA dependent coverage provision reduced high out-of-pocket health care spending for young adults. Health Aff 33(8):1361–1366
Collins SR, Robertson R, Garber T, Doty MM (2013) Insuring the future: Current trends in health coverage and the effects of implementing the Affordable Care Act. The Commonwealth Fund. http://www.commonwealthfund.org/Publications/Fund-Reports/2013/Apr/Insuring-the-Future.aspx
Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D (2016) Impacts of the affordable care act on health insurance coverage in medicaid expansion and non-expansion states. NBER Working paper 22182. www.nber.org
Currie J, Gruber J (1996) Health insurance eligibility, utilization of medical care, and child health. Q J Econ 111(2):431–466
French MT, Homer J, Gumus G, Hickling L (2016) Key provisions of the patient protection and affordable care act (ACA): a systematic review and presentation of early research findings. Health Serv Res 51(5):1735–1771
Golberstein E, Busch SH, Zaha R, Greenfield SF, Beardslee WR, Meara E (2015) Effect of the affordable care act’s young adult insurance expansions on hospital-based mental health care. Am J Psychiatry 172(2):182–189. https://doi.org/10.1176/appi.ajp.2014.14030375
Han X, Zhu S, Jemal A (2016) Characteristics of young adults enrolled through the affordable care act-dependent coverage expansion. J Adolesc Health 59(6):648–653
Han X, Zang Xiong K, Kramer MR, Jemal A (2016) The affordable care act and cancer stage at diagnosis among young adults. J Natl Cancer Inst 108(9)
Hernandez-Boussard T, Burns CS, Ewen Wang N, Baker LC, Goldstein BA (2014) The affordable care act reduces emergency department use by young adults: evidence from three states. Health Aff (Millwood). 33(9):1648–1654
Hernandez-Boussard T, Morrison D, Goldstein BA, Hsia RY (2016) Relationship of affordable care act implementation to emergency department utilization among young adults. Ann Emerg Med 67(6):714–720
Kozloff N, Sommers BD (2017) Insurance coverage and health outcomes in young adults with mental illness following the affordable care act dependent coverage expansion. J Clin Psychiatry 78(7):e821–e827
Look KA, Kim NH, Arora P (2017) Effects of the affordable care act’s dependent coverage mandate on private health insurance coverage in urban and rural areas. J Rural Health 33(1):5–11
McClellan S (2017) The affordable care act’s dependent care coverage and mortality. Medical Care. Epub. https://doi.org/10.1097/mlr.0000000000000711
Miller S (2012) The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform. J Public Econ 96(11):893–908
Mulcahy A, Harris K, Finegold K, Kellermann A, Edelman L, Sommers BD (2013) Insurance coverage of emergency care for young adults under health reform. New Engl J Med 368(22):2105–2112
O’Connell JM, Towles W, Yin M, Malakar CL (2002) Patient decision making: Use of and adherence to telephone-based nurse triage recommendations. Med Decis Mak 22(4):309–317
O’Hara B, Brault MW (2013) The disparate impact of the ACA-dependent expansion across population subgroups. Health Serv Res 48(5):1581–1592
Parsons HM, Schmidt S, Tenner LL, Bang H, Keegan T (2016) Early impact of the patient protection and affordable care act on insurance among young adults with cancer: analysis of the dependent insurance provision. Cancer 122(11):1766–1773
Ruggles S, Alexander JT, Genadek K, Goeken R, Schroeder MB, Sobek M (2010) Integrated public use microdata series: version 5.0 [machine-readable database]. Minneapolis: University of Minnesota. https://usa.ipums.org/usa/cite.shtml
Saloner B, Cook BL (2014) An ACA provision increased treatment for young adults with possible mental illnesses relative to comparison group. Health Affairs (Millwood). 33(8):1425–1434
Saloner B, Akosa Antwi Y, Maclean JC, Cook B (2017) Access to health insurance and utilization of substance use disorder treatment: evidence from the affordable care act dependent coverage provision. Health Econ. https://doi.org/10.1002/hec.3482
Scott JW, Rose JA, Tsai TC, Zogg CK, Shrime MG, Sommers BD, Salim A, Haider AH (2016) Impact of ACA insurance coverage expansion on perforated appendix rates among young adults. Med Care 54(9):818–826
Sommers BD, Kronick R (2012) The affordable care act and insurance coverage for young adults. J Am Med Assoc 307(9):913–914
Tumin D, Li SS, Kopp BT, Kirkby SE, Tobias JD, Morgan WJ, Hayes D (2017) The effect of the affordable care act dependent coverage provision on patients with cystic fibrosis. Pediatr Pulmonol 52(4):458–466
U.S. Census Bureau (2014) State characteristics datasets: annual estimates of the civilian population by single year of age and sex for the United States and States, 1 Apr 2010 to 1 July 2014. https://www.census.gov/popest/data/state/asrh/2014/files/SC-EST2014-AGESEX-CIV.csv
U.S. Department of Labor (2013) Young adults and the affordable care act: protecting young adults and eliminating burdens on business and families FAQs. http://www.dol.gov/ebsa/faqs/faq-dependentcoverage.html
U.S. Department of Labor (2011) Young adults and the affordable care act: protecting young adults and eliminating burdens on families and businesses. https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/fsdependentcoverage.pdf
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (2016) Prevention quality indicators overview. Retrieved from http://www.qualityindicators.ahrq.gov/modules/pqi_overview.aspx
Wallace J, Sommers BD (2015) The dependent care coverage expansion’s effect on health and access to care for young adults. JAMA Pediatrics. 169(5):495–497; Aldana SG, Merrill RM, Price K et al (2005) Financial impact of a comprehensive multisite workplace health promotion program. Prev Med 40(2):131–7
Acknowledgements
This study was funded by the Agency for Healthcare Research and Quality under contract HHSA-290-2013-00002-C. The views expressed herein are those of the authors and do not necessarily reflect those of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. No official endorsement by any agency of the federal or state governments, Truven Health Analytics or RAND Corporation is intended or should be inferred. No potential conflicts of interest exist.
The authors would like to acknowledge the following HCUP Partner organizations for contributing data to the HCUP State Inpatient Databases (SID) used in this study: Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, Wyoming. The authors would also like to acknowledge the following HCUP Partner organizations for contributing data to the HCUP State Emergency Department Databases (SEDD) used in this study: California, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Rhode Island, South Carolina, Tennessee, Wisconsin. A full list of HCUP Data Partners can be found at www.hcup-us.ahrq.gov/hcupdatapartners.jsp.
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Gibson, T.B. et al. (2018). Young Adults, Health Insurance Expansions and Hospital Services Utilization. In: Giabbanelli, P., Mago, V., Papageorgiou, E. (eds) Advanced Data Analytics in Health. Smart Innovation, Systems and Technologies, vol 93. Springer, Cham. https://doi.org/10.1007/978-3-319-77911-9_8
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