Health Insurance and Access Among Young Adults With Disabilities: Impacts of the Affordable Care Act

Background & Purpose:  One of the first implemented provisions in the Act allowed young adults to remain on their parents’ private health insurance plans, even if they were not full time students and until their 26^th birthday.  This age group had the highest risk of uninsurance, with over 30% uninsured prior to passage of the ACA.  This paper examines the impact of this provision of the Affordable Care Act (ACA) on health insurance and access to care among young adults with disabilities.  We hypothesize that rates of uninsurance will decline and access to care will increase among these young adults post-ACA.

Methods:  This paper uses linked National Health Interview Survey (NHIS) and Medical Expenditure Panel Study (MEPS) data to document changes in health insurance coverage, unmet or delayed needs for care, usual source of care and other medical home components among adolescents with disabilities as they transition into adulthood.  Disability is defined as meeting criteria for children with special health care needs (CSHCN) at age 17.  Subjects are identified at age 17 in the NHIS, then followed through age 19 or 20 in the MEPS.  The combined data allow for longitudinal analysis of health insurance coverage over a 3 year period.  Three panels of MEPS data were linked with NHIS data and then pooled to create a pre-ACA time period (last years included are 2005-2007).  Multivariate, difference-in-difference analysis is used to compare results from this pre-ACA time period with those from a post-ACA time period (two pooled MEPS panels, linked with NHIS; last years included are 2011-2012) with a combined sample size of 521 CSHCN. 

Results:  Preliminary results show a significant reduction in insurance coverage over the three years examined pre-ACA (a 14 percentage point decline), and no reduction in insurance coverage during transition in the post-ACA period (a 3.6 percentage point increase).  Pre-ACA, the largest drops in coverage were among those with Medicaid/SCHIP and private insurance; post-ACA, these coverage declines disappear.  No changes in the percent with a usual source of care or with unmet or delayed needs for care are observed among this group of 17-20 year olds, though sensitivity analysis show differences pre- and post-ACA among older young adults (those 21-25 years old). 

Conclusions & Implications:  Young adults with disabilities have historically struggled to meet their health care needs and this provision in the ACA appears to have had a positive impact.  Continuous health coverage is necessary for these young adults to maintain and/or improve function, and may work in tandem with other supports to improve their likelihood of employment and independent living.   Further research should examine these possible secondary benefits.