Author Insights: More Young Adults Insured After Health Reform Law Passed

Benjamin D. Sommers, MD, PhD, and his colleague Richard Kronick, PhD, both of the US Department of Health and Human Services, found that the health reform law helped boost insurance rates among young adults. (Image: Harvard University)

A popular provision of the Affordable Care Act that allowed young adults to remain covered by a parent’s health insurance policy until age 26 years appears to be having the intended effect of boosting the number of individuals in this age group who are insured, according to analysis by scientists from the US Department of Health and Human Services, published in JAMA today.

Preliminary data from the National Health Interview Survey from the US Centers for Disease Control and Prevention (CDC) indicate that an estimated 2.5 million individuals aged 19 to 25 years gained insurance in the period between the enactment of the law in September 2010 and June 2011. To address questions about how much of this increase could be attributed to the law and whether all groups benefited, Benjamin D. Sommers, MD, PhD, and Richard Kronick, PhD, analyzed data from the US Census Bureau’s Current Population survey for the calendar years 2005 to 2010. They found a net gain in coverage of 2.9% among young adults covered by the law compared with the percentage of young adults aged 26 to 34 years who had coverage over this period, a group among whom the rate of coverage actually decreased during the same period.

Minorities experienced even greater net increases in coverage, ranging from a 3.5% net increase among black 19- to 25-year-olds compared with 26- to 34-year-olds to an 18.4% net increase among Native American young adults.

Dr Sommers discussed the findings with news@jama via e-mail.

news@jama: Why did you decide to do this analysis?

Dr Sommers: We wanted to see how much of this increased coverage was due to the law, as opposed to more Medicaid coverage or changes in the economy. We also wanted to see what the trends looked like for different racial and ethnic groups. What we found is that all of the increased coverage came from adults getting private insurance on their parents’ plans, with no change in Medicaid coverage, just as we would expect under the law. And we found that the increases in coverage were broad-based among all racial and ethnic groups, with the largest gains among minorities.

news@jama: Do you think the increases in rates of insured were as large as they could be?

Dr Sommers: We found significant increases in coverage for all groups, so the policy is definitely working. The policy began to take effect in September 2010, but its effects are gradual, as insurance plans renewed over the following 12 months. It’s important to remember that our data only run through the end of 2010, and many insurance plans begin enrollment in January. As more recent data become available, we expect the number of people benefiting to continue to rise—and this is a pattern we’ve already seen in the results from the CDC.

news@jama: Did you learn anything policy makers might want to take into account as they move forward?

Dr Sommers: It’s very encouraging news, because this is an age group that has traditionally had the lowest rates of insurance coverage in the country. And now we find that the law was particularly beneficial among some of the minority groups in the US that have had lower rates of insurance in the past. Our results suggest that policy makers should take steps to protect the gains in coverage created by the Affordable Care Act and continue to work to implement the remaining parts of the law’s coverage expansions.

news@jama: Are there other questions that remain to be answered?

Dr Sommers: Coverage is the first step. Future research will help measure some of the implications of the expanded coverage, in terms of potential gains in access to care, use of preventive services, and better health.

news@jama: What is the main take-home message?

Dr Sommers: The Affordable Care Act is already improving coverage for young adults of all races and ethnicities, and sustained support for the law’s implementation over the coming years will be critical to expanding coverage to tens of millions more Americans.



Categories: Caring for the Uninsured and Underinsured, Health Policy, Primary Care/Family Medicine, Public Health

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