Abstract
Background: In the United States, prior to the implementation of the Affordable Care Act Dependent Coverage Expansion (ACA-DCE) in September 2010, many states had made similar expansion of coverage to young adults, although with varying requirements based on age limits, marital status, student status and other factors.
Objective: To examine if healthcare-related changes among young adults after the ACA-DCE differed by the states’ prior reform status.
Methods: Young adults aged 19-34 were identified from the 2004-2013 Medical Expenditure Panel Survey, a national household interview survey in the U.S. Quasi-experiment design and difference-in-differences analyses were conducted to examining the changes in insurance coverage, annual care utilization, and medical expenditures and self-reported after the implementation of the ACA-DEC among adults aged 19-25 years, using those aged 26-34 as controls; the analyses were stratified by states’ prior expansion status.
Results: While insurance coverage increased nationwide among 19-25-year-olds after the implementation of the ACA-DCE, its spillover effects on dental insurance and prescription insurance and its effects on healthcare spending and overall health status were only seen for those residing in states that expanded dependent coverage prior to the ACA.
Conclusions: State policies may have facilitated the effects from the ACA-DCE on healthcare delivery among young adults. Future studies evaluating effects of the ACA should consider state variations when possible, even for the provisions that apply to all states uniformly.
Key words: Affordable Care Act, young adults, care utilization, medical expenditures, spillover effect.