Young adults report improved health and lower out-of-pocket costs after a provision of the Affordable Care Act (ACA) went into effect in 2010 that allows individuals to obtain health insurance through a parent’s policy until their 26th birthday. Before the ACA, dependent children were often “aged out” of a parent’s plan at age 19 years, or age 22 years if they were full-time students.
Much debate has centered on whether the implementation of the ACA would help or hurt young people. Some provisions have made it easier for young adults to access insurance either through a parent’s plan or, starting in 2014, by purchasing insurance through a state or federal health insurance exchange. However, some concerns have been raised that young people may pay higher premiums to offset the health costs of older or less healthy individuals obtaining coverage through the health exchanges.
Although it’s too soon to assess how young adults are faring in the health insurance exchanges, analyses have suggested that allowing young adults to stay on their parents plan increased health insurance coverage among younger adults. An analysis appearing in today’s JAMA, by Kao-Ping Chua, MD, a pediatrician in the division of emergency medicine at Boston Children’s Hospital, and Benjamin D. Sommers, MD, PhD, of Harvard University’s School of Public Health, examined health insurance coverage, health spending, and self-reported health of adults younger than 26 years before and after the 2010. Adults aged 26 through 34 years were used as a control group. They found that adults younger than 26 years saved on out-of-pocket costs after the provision became effective and reported better physical and mental health compared with those aged 26 through 34 years, who were too old to benefit from the provision.
Chua, who is also a student in the Harvard PhD Program in Health Policy, discussed the findings with news@JAMA:
news@JAMA: Why did you decide to do this study?
Dr Chua: I decided to do the study because young adults have had the highest rate of uninsurance in the United States, leading to poorer health and a higher risk of catastrophic health costs.
Previous research showed that both low-income individuals in Oregon who gained Medicaid coverage through a lottery system and elderly adults who gained Medicare insurance have improved health. The incidence of catastrophic medical expenses also decreased for those who gained Medicaid coverage in Oregon.
news@JAMA: How do your findings add to previous research on this provision of the ACA?
Dr Chua: Ours is the first that looked at medical spending using the Medical Expenditure Panel Survey (an annual survey of US health expenditures). Other studies have looked at health insurance coverage and utilization but have not had as much detail on medical spending.
The biggest finding is that the share of all healthcare expenditures paid out-of-pocket decreased, by about 3.7 percentage points. That suggests that having health insurance is doing what it’s supposed to be doing, protecting people against the high cost of health care.
news@JAMA: Why do you think those who were eligible for coverage under the provision reported better physical and mental health?
Dr Chua: In the Oregon Medicaid expansion experiment, the authors showed that those who were selected to receive coverage reported better mental and physical health even before changes in utilization began. Just knowing you will have access may improve a person’s sense of well-being.
We only had 1 year of utilization data, so that may have made it difficult to detect small changes in utilization. Our analysis suggests that primary care use increased by 2.2%, but the finding wasn’t statistically significant. Our study may not have had the power to detect smaller differences.
news@JAMA: Your sample was predominantly (73.9%) white. Is there any reason to think the results might be different in other demographic groups?
Dr Chua: There have been other studies suggesting that certain racial and ethnic groups were more or less likely to gain coverage. But young adults of all races gained insurance. There may be differences in magnitude, but all groups gained in some way.
Our study was not powered to look at subgroups. So future research would need to address differences in health spending among racial and ethnic groups.
news@JAMA: Are there any other research questions that remain to be answered?
Dr Chua: This particular data set didn’t include objective health measures, like blood pressure readings. It would be interesting to look at the effect of this provision on objective health measures using other data sets.