Association for Public Policy Analysis & Management

Prior to the passage of the Affordable Care Act (ACA) in 2010, young adults aged 19-25 had the highest uninsured rate in the United States population compared to other age groups (Cohen & Martinez, 2014). While young adults are generally healthier than their older counterparts, uninsured young adults are less likely to have contact with a health professional or engage in preventative care, and have a higher probability of forgoing medical care or not filling prescriptions due to costs (Callahan & Cooper, 2005; Collins, Robertson, Garber, & Doty, 2012). More than half of the young adults who do seek care have significant problems paying off their medical bills. These difficulties with health care access and utilization are especially exacerbated for low-income young adults who lack the financial resources to meet their health care needs, and are often unable to rely on parental dependent coverage.

Under the ACA, states had flexibility to expanded Medicaid eligibility to adults with incomes up to 138 percent of the federal poverty level. To date, thirty-four states including the District of Columbia have implemented the Medicaid expansion policy. While a few recent studies have highlighted that ACA Medicaid expansion improved insurance coverage for young adults (Lipton, Decker, & Sommers, 2019; McMorrow, Kenny, Long, & Anderson, 2015; Wisk & Sharma, 2019), no research to date has specifically examined the impact of this policy change on the health status and financial well-being of low-income young adults. In this study, I examine whether Medicaid expansion under the ACA had a positive impact on the health and health care access of low-income young adults, as well as on their financial well-being.

I exploit the variation in Medicaid expansion across states and over time to identify the casual effect of Medicaid expansion on the outcomes of interest for low-income young adults. Data on young adults’ self-reported health, mental health status, insurance coverage, healthcare access and utilization, and financial well-being are obtained from the National Health Interview Survey (NHIS) public and restricted data files. I estimate difference-in-differences models comparing outcomes among low-income childless young adults in expansion and non-expansion states, before and after the policy change. In addition to the main analyses, models are also estimated separately to determine if expanding Medicaid eligibility had differing effects for gender and racial groups among the low-income young adult population.

The results from this study will provide essential knowledge on the effect public health insurance can have on the lives and well-being of disadvantaged groups, as well as on reducing disparities in health outcomes among young adults. With continued debate in some states on whether the Medicaid expansion policy should be adopted, the empirical evidence from this study can be used to inform this policy decision.