Inequalities in Young Adult Health Insurance Coverage Post-federal Health Reform

• Published in: Journal of general internal medicine : JGIM Vol. 34; no. 1; pp. 65 - 74
• Main Authors: Wisk, Lauren E., Sharma, Niraj
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2019; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Adult; Adults; Age; Cross-Sectional Studies; Estimators; Female; Females; Government programs; Health; Health care; Health Care Reform; Health insurance; Health Services Accessibility - organization & administration; Health Surveys; Humans; Inequalities; Insurance; Insurance coverage; Insurance Coverage - statistics & numerical data; Internal Medicine; Male; Medically Uninsured - statistics & numerical data; Medicine; Medicine & Public Health; Minority & ethnic groups; Occupational health; Original Research; Patient Protection and Affordable Care Act; Retrospective Studies; Sociodemographics; Socioeconomic Factors; Socioeconomics; Subgroups; Teenagers; United States; Young Adult; Young adults; Youth; United States; adolescence; health care disparities; young adult; National Health Policy; insurance coverage
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-018-4723-0

Background Uninsurance for young adults (YAs) was greatly reduced by the Affordable Care Act (ACA). However, reforms may not be equally beneficial for all YAs and certain policies may exacerbate, rather than resolve, pre-existing disparities. Objective To investigate inequalities in YAs’ insurance coverage pre- (2000–2010) and post-federal health reforms (dependent coverage expansion, 2010–2013, and Medicaid/Marketplace expansions, 2014–2016), among a nationally representative sample. Design A difference-in-differences estimator (controlling for sociodemographics) was used to determine the effects of the ACA for young adults (ages 19–25) compared to adolescents (ages 13–18) and older YA (ages 26–30) counterparts; triple-difference estimators quantified differential policy effects by sociodemographics. Participants Three hundred eighty-seven thousand six hundred thirty-five participants in the 2000–2016 National Health Interview Survey. Main Measures Respondents reported their health insurance coverage types during the last 12 months, reasons uninsured, and detailed sociodemographics. Key Results An adjusted difference-in-differences estimator quantified a 12.3 percentage point increase ( p  < 0.0001) in full-year coverage post-ACA for YAs compared to older counterparts, driven by increases in employer-sponsored private insurance while younger and older youth saw larger gains in Medicaid coverage. Triple-difference estimators identified subgroups experiencing less beneficial dependent coverage expansion effects, including females, lower socioeconomic status, non-citizens, non-English speakers, and several racial/ethnic minority groups. Later ACA reforms (Marketplace/Medicaid expansions) mitigated many of these widening disparities. Conclusion While the ACA significantly impacted YA insurance coverage, these gains were not of equal magnitude for all YAs and disparities remain. As such, more work needs to be done to ensure optimal and equitable access to high-quality, affordable insurance for all YAs.