Association for Public Policy Analysis & Management

This study evaluates whether young adults are differentially affected by health insurance expansions based on family nativity. It considers two new ways for young to access health insurance related to the Affordable Care Act: extended dependent coverage under their parents’ private insurance plans to age 26, and early Medicaid expansions at state-determined percentages of federal poverty. This study investigates whether young adults are differentially impacted by the two policies—individually and in combination—based on their family nativity. I focus on citizen young adults in order to highlight the importance of family background independent of one’s own status, and also to engage with policymakers across the political spectrum with respect to immigration.

The American Community Survey (ACS) is a large, nationally representative dataset with demographic and insurance variables that allows for analysis at the state level, making it ideal for this study. Since the early Medicaid states each implemented idiosyncratic income eligibility limits, and expansion states are often different from nonexpansion states in terms of demographics and policy climates, I employ the synthetic control case study method to construct a control state for each treated state. I use these in difference-in-differences analyses of the Medicaid policies on citizen young adults, from immigrant and from native families, in several early Medicaid expansion states.

At the national level, I also conduct a difference-in-differences analysis of the private insurance expansion to dependent adults. I compare citizen young adults up to age 26 with older counterparts up to age 35 who, because of their age, are not eligible for the extension of private coverage. Preliminary analyses show that, because of their families’ lower access to private health insurance, private coverage takeup was higher for young adults from native families than for those with immigrant backgrounds, and that these effects are statistically distinguishable from one another.

While the future of healthcare reform is unknown in this time of political transition, we can expect that states will have varied responses to a full repeal or other federal changes. This study will provide evidence about how state policies can impact difficult-to-insure young populations that are critical to insurance risk pools, and how family nativity may predict health insurance coverage characteristics.