One of the most popular provisions of the Affordable Care Act is the one that allows young adults up to age 26 to stay on their families' plans. Since this age group is pretty healthy in general, the cost of allowing them to remain on others' plans is relatively low. It's also resulted in what appear to be significant drops in the uninsurance rate for those in this age group.
A recent study in JAMA Pediatrics explores this phenomenon further. "Limited Impact on Health and Access to Care for 19- to 25-Year-Olds Following the Patient Protection and Affordable Care Act":
IMPORTANCE The Patient Protection and Affordable Care Act (PPACA) allowed young adults to remain on their parents’ insurance until 26 years of age. Reports indicate that this has expanded health coverage.OBJECTIVE To evaluate coverage, access to care, and health care use among 19- to 25-year-olds compared with 26- to 34-year-olds following PPACA implementation.
DESIGN, SETTING, AND PARTICIPANTS Data from the Behavior Risk Factor Surveillance System and the National Health Interview Survey, which provide nationally representative measures of coverage, access to care, and health care use, were used to conduct the study among participants aged 19 to 25 years (young adults) and 26 to 34 years (adults) in 2009 and 2012.
EXPOSURE Self-reported health insurance coverage.
MAIN OUTCOMES AND MEASURES Health status, presence of a usual source of care, and ability to afford medications, dental care, or physician visits.
Researchers in this study used data from the BRFSS and the NHIS to look at both access and utilization of health care for young adults age 19 to 25 years. They also looked at adults 26 to 34 years as a comparator. They did this in both 2009 (before the new provision) and in 2012 (after it). The main exposure of interest was, of course, whether they were insured. The main outcome measures were their health, whether they had a usual source of care, and how they rated their ability to afford care.
Confirming previous reports, the percentage of young adults who were insured increased from 2009 to 2012, from 68% to 72%. The percentage of adults who were insured, however, dropped dramatically over this time, from 78% to 70%. In this respect, it appears that the new provision was associated with significant improvements in insurance compared to adults 26+. Both groups reported a decrease in having a usual source of care, but the decrease was less for young adults, likely because adults saw a much higher drop in their chance of being insured.
However, there was no improvement in the chance that young adults went for a routine checkup. Young adults saw no greater improvement in their health status compared to adults over this time. They were not more likely to be able to afford prescription drugs, dental care, or visits to the doctor. They weren't even more likely to get a flu shot.
As with any study, this one has limitations. All of these data are self-reported, so it's possible that improvements occurred but aren't being seen. It may take a longer time for the effects of coverage to have an impact on utilization or health. It may be that the accompanying downturn in the economy had a large effect that washed out that of insurance.
But the bottom line is that this confirms something we need to acknowledge. Access is necessary, but not sufficient, for good health. Many other things matter, too. In terms of improving the health care system, improving access and reducing uninsurance is almost the easiest step. Improving quality is much harder. But if we want better outcomes, we need to do it.
–Aaron