Table B2:
Preliminary Findings of Effects of ACA on Access to Health Care for Young Adults.
| Study | Data source(s) |
Study design | Findings |
|---|---|---|---|
| Abraham (2014) | MEPS | - Calculations based on quasi-experimental literature | - Using 2008–2011 data, ACA is estimated to increase office visits between 33 million and 149 million annually |
| Antwi et al. (2015a) | NIS | - Difference-in-differences model with
year, seasonality, and hospital fixed effects - Study period: 2007–2011 - Treatment group: ages 19–25; comparison group: ages 27–29 |
- 3.5% increase in inpatient visits
amongyoungadults ages 19–25, as compared to 27- to
29-year-olds - 9.0% increase in visits related to mental illness |
| Antwi et al. (2015b) | HCUP NEDS |
- Difference-in-differences model with
age, year, and seasonality fixed effects - Study period: pre-ACA 2007–2009; post-ACA 2011 - Treatment group: ages 19–25; comparison group: ages 27–34 |
- Quarterly emergency department visit
rate decreased 1.6pp per 1000 young adults ages 19–25,
compared to adults ages 27–34 - Largest decreases for women, weekday visits, nonurgent conditions, and conditions that could be treated elsewhere |
| Barbaresco et al. (2015) | BRFSS | - Difference-in-differences model with
age, state, and time fixed effects - Study period: 2007–2013 - Treatment group: ages 23–25; comparison group: ages 27-29 |
- ACA dependent coverage provision
increased likelihood of having primary care physician by
1.8pp–3.9pp - Decreased likelihood of forgoing medical care due to cost by 2.2pp–2.8pp among 23- to 25-year-old adults - Decreased likelihood of receiving flu vaccine by 2.1pp–2.7pp |
| Busch et al. (2014) | MEPS | - Difference-in-differences model with
age and time fixed effects - Study period: pre-ACA 2007–2009; post-ACA 2010-2011 - Treatment group: ages 19–25; comparison group: ages 26–29 |
- Significant reduction in share of young adults ages 19–25 with annual out-of-pocket expenditures exceeding $1500 (4.2%–2.9%) following ACA, as compared to those ages 26–29 |
| Chen et al. (2015) | MEPS | - Difference-in-differences - Study period: pre-ACA 2008–2009; post-ACA 2011–2012 - Treatment group: ages 19–26; comparison group: ages 27–30 |
- White and African American young adults ages 19–26 had significantly lower total health spending in 2011 and 2012 as compared to those ages 27–30 |
| Chua and Sommers (2014) | MEPS | - Difference-in-differences - Study period: 2002–2011 - Treatment group: ages 19–25; comparison group: ages 26–34 |
- No significant changes in health
care use (outpatient, primary care, or emergency department
visits; hospitalizations; prescription fills) - 3.7pp decrease in out-of-pocket expenditure rate among 19–25 year-olds as compared to 26–34 year olds, corresponding to an 18% reduction in out-of-pocket expenditures |
| Golberstein et al. (2015b) | NIS California SID and SEDD |
- Difference-in-differences model with
age and time fixed effects - Study period: 2005–2011 - Treatment group: ages 19–25; comparison group: ages 26–29 |
- 0.14 more inpatient admissions for
psychiatric diagnoses per 1000 among 19- to 25-year-olds than
26- to 29-year-olds - 0.45 fewer psychiatric emergency department visits per 1000 California 19-to 25-year-olds than 26-to 29-year-olds |
| Han et al. (2014) | MEPS | - Difference-in-differences - Study period: pre-ACA 2009; post-ACA 2011-2012 - Treatment group: ages 19–25; comparison group: ages 26–30 |
- Adults ages 19–25 were
significantly more likely to receive a dental checkup, blood
pressure measurement, and routine health checkup after
implementation than those ages 26–30 - No significant change in flu vaccination or pap smear rates |
| Hernandez-Boussard et al. (2014) | HCUP SIDs HCUP SEDDs |
- Difference-in-differences model with
age, state, and year fixed effects - Study period: 2009–2011 - Treatment group: ages 19–25; comparison group: ages 26–31 |
- Decrease of 2.7 emergency department visits per 1000 young adults ages 19–25 |
| Kotagal et al. (2014) | BRFSS NHIS |
- Difference-in-differences - Study period: pre-ACA 2009; post-ACA 2012 - Treatment group: ages 19–25; comparison group: ages 26–34 |
- Decrease in likelihood of having a
usual source of care for young adults ages 19–25 and
adults ages 26–34 between 2009 and 2012, though larger
decrease for latter group - No significant change in rates of young adults receiving routine checkup or flu shot in last year |
| Lau et al. (2014) | MEPS | - Pre-post design with multivariate
logistic regression - Study period: pre-ACA 2009; post-ACA 2011 - Study group: ages 18–25 |
- Between 2009 and 2011, young adults
ages 18–25 had significantly higher rates of routine exam
receipt (44% vs. 48%), blood pressure screening rates (65% vs.
68%), cholesterol screening rates (24% vs. 29%), and annual
dentalvisit rates (55% vs. 61%) - Insurance status fully accounted for differences in routine exam and blood pressure screening rates |
| Lipton and Decker (2015) | NHIS | - Difference-in-differences model with
age and year fixed effects -Study period: 2008–2012 - Treatment group: women ages 19–25; comparison group: women ages 18 or 26 |
- ACA increased likelihood of HPV vaccine initiation by 7.7pp and HVP vaccine completion by 5.8pp for women ages 19–25 relative to women age 18 or 26 |
| Saloner and Le Cook (2014) | NSDUH | - Difference-in-differences - Study period: 2008–2012 - Treatment group: ages 18–25; comparison group: ages 26–35 |
- 5.3pp increase in mental health treatment rates for young adults ages 18–25 with possible mental health disorders, as compared to 26- to 35-year-old adults |
| Scott et al. (2015) | National Trauma Data Bank |
- Difference-in-differences model with
facility-level fixed effects - Study period: pre-ACA 2007–2009; post-ACA 2011–2012 - Study population: individuals with trauma patient experience - Treatment group: ages 19–25; comparison group: ages 26–34 |
- No significant changes in use of intensive care among young adult trauma patients ages 19–25, as compared to similar adults ages 26–34 |
| Slusky (2012) | CPS ASEC BRFSS CE |
- Difference-in-differences model with
age, state, and time fixed effects - Study period: pre-ACA 2005–2009; post-ACA 2011 - Treatment group: ages 19–25; comparison group: ages 16–18 and 27–29 |
- Young adults ages 19–25 are
2-3pp more likely to have personal doctor than individuals ages
16–18 and 27–29 - Young adults l–2pp less likely to forgo care due to cost - Young adults spent average of $45 to $60 per 3 months less on health insurance |
| Sommers et al. (2013) | NHIS CPS ASEC |
- Difference-in-differences - Study period: 2005–2010 - Treatment group: ages 19–25; comparison group: ages 26–34 |
- Significant reduction in number of young adults ages 19–25 delaying care or not receiving needed care due to cost, as compared to adults ages 26–34 |
| Vujicic et al. (2014) | NHIS | - Difference-in-differences - Study period: pre-ACA 2008–2010; post-ACA 2011–2012 - Treatment group: ages 19–25; comparison group: ages 26–34 |
- Coverage of private dental benefits
increased 6.9pp foryoung adults ages 19–25 between 2008
and 2012, compared to those ages 26–34 - Dental care utilization increased 3.3pp foryoung adults vs. those ages 26–34 during this time |
| Wallace and Sommers (2015) | BRFSS | - Difference-in-differences model with
state and time fixed effects - Study period: 2005–2012 - Treatment group: ages 19–25; comparison group: ages 26–34 |
- Young adults ages 19–25, 2.4pp more likely to have usual source of care and 1.9pp less likely to be unable to receive care due to cost than adults ages 26–34 |