Insurance Coverage of Emergency Care for Young Adults Under Health Reform

Published in: The New England Journal of Medicine, v. 368, no. 22, May 30, 2013, p. 2015-2112

Posted on RAND.org on December 31, 2012

by Andrew W. Mulcahy, Katherine M. Harris, Kenneth Finegold, Arthur L. Kellermann, Laurel Edelman, Benjamin D. Sommers

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Research Question

  1. Is the dependent coverage provision of the Affordable Care Act having its intended effect of shielding young adults from the health and financial consequences of going without insurance?

BACKGROUND: The Affordable Care Act (ACA) established nationwide eligibility for young adults 19 to 25 years of age to retain coverage under their parents' private health plans. We conducted a study to determine how the implementation of this provision changed rates of insurance coverage for young adults seeking medical care for major emergencies. METHODS: We evaluated more than 480,000 nondiscretionary visits made to emergency departments from 2009 through 2011, as recorded in a large, geographically diverse data set of hospital claims, to estimate how the ACA provision affected private insurance coverage of such visits by young adults (19 to 25 years of age). To adjust for underlying trends in insurance coverage, we compared changes in the target age group with changes among adults 26 to 31 years of age, who were unaffected by the provision (control group). RESULTS: After the ACA provision took effect, private coverage of nondiscretionary visits to emergency departments by young adults increased by 3.1 percentage points (95% confidence interval [CI], 2.3 to 3.9; relative increase, 5.2%; P<0.001), as compared with similar visits in the control group. The percentage of visits by uninsured young adults also fell significantly (−1.7 percentage points; 95% CI, −2.8 to −0.7; relative decrease, 9.1%; P<0.001). The rates of nondiscretionary visits that were covered by Medicaid or other nonprivate insurers remained relatively steady throughout the study period. The coverage expansion led to an estimated 22,072 visits to emergency departments by newly insured young adults and $147 million in associated costs that were covered by private insurance plans during a 1-year period. CONCLUSIONS: Enactment of the dependent-coverage provision was associated with a significant increase in the proportion of young adults who were protected from the financial consequences of a serious medical emergency.

Key Findings

During 2011, about $147 million in emergency department and hospital costs were paid from private insurance pools, due to the new provision.

Without the provision, some of these costs would have become the burden of patients and their families, or would have been uncompensated care, generating a financial burden for hospitals and emergency care providers.

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