Paper: The Effects of the ACA: Young Adult Dependent Coverage Expansion on Health (2014 APPAM Fall Research Conference(November 5-8, 2014))

Thursday, November 6, 2014 : 10:15 AM

Ballroom A (Convention Center)

*Names in bold indicate Presenter

Marguerite Burns and Barbara Wolfe, University of Wisconsin – Madison

Importance. The health insurance rate for young adults rose by approximately 5 percentage points after the Affordable Care Act’s (ACA) expansion of health insurance for dependents, ages 19 to 25. Few would argue, however, that this increased rate of insurance coverage reflects the final objective of the expansion. Insurance coverage for young adults is a potential means to other ends including: financial protection from catastrophic medical expenses; and improved health care access, utilization, and health. A growing body of evidence demonstrates that the expansion did indeed increase young adults’ financial protection from medical expenses and influence their health care use. Less clear is the policy’s effect on health.

Objective. To evaluate the effect of the ACA young adult dependent coverage expansion on changes in self-reported physical and mental health in a national sample of young adults.

Design, Setting, and Participants. We use the Medical Expenditure Panel Survey to compare 2009 and 2011 outcomes for the group that experienced the insurance expansion (young adults) to those for adults ages 26 to 30 using a difference-in-differences (DD) framework. We estimate separate regression models for women and for men including ordered probit for ordinal outcomes and linear regression. The unweighted sample size is 14,891 individuals.

Main Outcomes and Measures. Outcome measures include: ordinal measures of mental and of physical health; binary indicators for a positive depression screen (PHQ2) and for a positive screen for psychological distress (K6); and the SF-12 Health Survey mental (MCS) and physical health (PCS) component scores.

Results. We find a relative reduction of 4 percentage points (pp) in the proportion of young women that screened positive for depression, and an improvement in the MCS score. The relative likelihood that young women reported excellent mental health increased by 5 pp post-ACA. Notably, we find offsetting declines in the probability of each of the four lesser health states. We observe similar results for young women’s self-reported physical health although the estimates were less precise. There were few relative changes in health status for young men; none of them met conventional levels of statistical significance.

Conclusions and Relevance. The importance of young adult participation in the insurance exchanges for the stability of the health insurance market is well recognized. This study suggests that the expansion under the ACA to young adults may improve health and well-being for women. The expansion yielded significant improvements in self-reported health for young women, most prominently with respect to mental health. This finding coupled with prior research demonstrating the policy’s positive effects on financial protection suggests a mechanism by which health insurance may influence young women’s health. The expansion’s limited short-term effect on young men’s health particularly in light of their substantial gains in insurance coverage requires further exploration.

Panel Paper: The Effects of the ACA: Young Adult Dependent Coverage Expansion on Health