Last Fall, I wrote about some research on how the ACA's young adult provision seems to have impacted outcomes. The short of it was: not too much. But research continues, and a new study from the Journal of Health Economics gives us another data point. "Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults":
The first major insurance expansion of the Affordable Care Act – a provision requiring insurers to allow dependents to remain on parents’ health insurance until turning 26 – took effect in September 2010. We estimate this mandate's impacts on numerous outcomes related to health care access, preventive care utilization, risky behaviors, and self-assessed health. We estimate difference-in-differences models with 23–25 year olds as the treatment group and 27–29 year olds as the control group.
This study used the Behavioral Risk Factor Surveillance System (BRFSS), a phone survey conducted by state health departments with help from the CDC to collect data on health and behaviors from a national sample. Because it is conducted in waves, data exist both before and after the young adult provisions of the ACA went into effect. For the purpose of these analyses, the researchers compared people age 23-25 to those 27-29. Those who were 26 year olds were excluded because they could fall into either group depending their birthday.
Access-related outcomes of interest included whether young adults had health insurance, had a primary care physician, or had avoided care because of cost in the previous year. They measured preventive care utilization by flu vaccination rates, check-up rates, and PAP tests for women. Risk factors measured included alcohol use, tobacco use, BMI, obesity, and exercise. Finally, measures were created for both physical and mental health, as well as overall health. Analyses controlled for many factors, which are all listed in the manuscript.
One of the clearest results is that access improved along a number of dimensions. The insurance coverage rate among 23-25 year olds improved about 6%. The probability of having a primary care doctor increased by 2-3%, and the chance of avoiding care because of cost dropped about 2%.
However, like in prior work, access does not completely translate into utilization. There was no increase in preventive care utilization. If anything, the rates of flu vaccinations and pap tests seemed to go down after the young adult provision began.
Most risky behaviors were unaffected by the young adult provision, but the probability of risky drinking went up about 1%. BMI went down, though, as did obesity in a number of models.
Measures of health were improved by the provision, however. Overall excellent health went up about 1.5% and very good/excellent health went up just under 2%. Only the former was statistically significant, though. Most of the individual measures of physical or mental health were unaffected by the changes in insurance.
The ACA has been in effect for about 5 years now, and everyone wants to talk about whether it's a success or not. This paper is an attempt to answer that question for the young adult provision. The answer remains, unfortunately, complicated. These results suggest, once again, that while access improved, the utilization of preventive care did not. The effect on risky behaviors was mixed. And self-reported health improved at the high end of the spectrum. It appears that the ACA continues to make it potentially easier for people to get care if they need it, but the direct effects of them using that care - those outcomes aren't as easy to see.