Coverage of ED Visits for Young Adults under the ACA

One of the provisions of the Patient Protection and Affordable Care Act (ACA) became effective on September 23, 2010. As of that date and in all states, all adults between 19 and 25 years of age are eligible for health insurance coverage under a parent’s employer-sponsored or individually purchased plan.

In 2009, >25% of adults 18 to 34 years of age in the United States did not have health insurance coverage. Lack of coverage leaves young adults vulnerable to financial harm and is associated with lack of access to care. In addition, the burden of care for those young adults without coverage may fall to hospitals, which are required to provide emergency care to all in need.

A recent report from the Centers for Disease Control and Prevention estimated that the ACA provision provided coverage to an additional 3.1 million young adults. However, it is unclear whether the coverage expansion has provided financial protection to individuals and healthcare providers. Researchers recently conducted a study to determine how the implementation of the provision changed the rates of insurance coverage for young adults seeking medical care for major emergencies. They reported study results in the New England Journal of Medicine [2013;368(22):2105-2112].

The researchers utilized data from the IMS Health Charge Data Master database. The data extract included all visits to the emergency department (ED) made by adults 19 to 31 years of age from January 2009 through December 2011. To adjust for underlying trends in insurance coverage, the researchers 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). Those who were affected by the ACA provision were 19 to 26 years of age (young adults).

The unadjusted trends in the proportion of nondiscretionary ED visits that were covered by private insurance or other payers shifted upward in January 2011 among young adults who were eligible for the dependent-coverage provision; the upward trend was less pronounced among those in the control group.

Among the young adults, private coverage increased by 3.1 percentage points (95% confidence interval [CI], 2.3-3.9; relative increase, 5.2%; P<.001), compared with similar visits in the control group. In addition, the percentage of ED visits by uninsured young adults fell significantly (-1.7 percentage points; 95% CI, -2.8 to -0.7; relative decrease, 9.1%; P<.001).

The rates of nondiscretionary ED visits covered by Medicaid or other nonprivate insurers remained steady throughout the study period.

The expansion of eligibility for coverage led to an estimated 22,072 ED visits by newly insured young adults and $147 million in associated costs that were covered by private insurance plans in 2011, following the full implementation of the dependent-coverage ACA provision.

In summary, the authors said, “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.”