Health Insurance Coverage Among Young Adults with Disabilities: Impacts of the Affordable Care Act

Background & Purpose:  One of the first implemented provisions in the 2010 Patient Protection and Affordable Care Act (ACA)required insurance companies in the US to allow young adults to remain on their parents’ private health insurance plans, even if they were not full time students and until their 26th birthday.  This 19-25 year old age group had the highest risk of uninsurance, with over 30% uninsured prior to passage of the ACA, while uninsurance rates among teens (ages 13-18) were less than 10% in 2008-2010.  As these teens age into young adulthood, the coverage rules change for both public and private health insurance.   This study investigates the impact of the ACA on health insurance coverage for young adults with disabilities (ages 19-25), comparing their experience with that of teens with disabilities (ages 13-18).  We hypothesize that insurance coverage rates, particularly private coverage, will increase among the young adult group post-ACA.

Methods:  Multivariate, difference-in-difference analysis was used to compare results from two time periods of data from the National Health Interview Survey (NHIS): pre-ACA (combining data from 2006-2009) and post-implementation of the dependent coverage provision (combining data from 2011-2014).  The final unweighted sample size was 7,595. 

Results:  Multivariate results show a lower rate of private insurance coverage (a gap of 20.6 percentage points) and a higher rate of public insurance coverage (a gap of 8 percentage points) for young adults with disabilities than for teens with disabilities, pre-ACA.  Young adults disproportionately gained private insurance coverage post-ACA, reducing the gap in private coverage by 5.4 percentage points, with no significant change measured in the public coverage gap between these two groups.  These insurance changes affected nearly 300,000 young adults with disabilities.  These results will be updated to include the 2015 NHIS, and will focus on our analysis of differences in insurance coverage changes for these groups by states that have or have not expanded Medicaid, and by urban and rural areas in states that have or have not expanded Medicaid. We have been approved to use restricted NHIS data (state and urban/rural identifiers), but are waiting for the 2015 data to be released (in June 2016) to complete this analysis.

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 young adults with disabilities to maintain and/or improve function.  Decoupling health insurance from both employment and the social welfare system should improve insurance coverage rates, and may improve the likelihood of employment and independent living for young adults with disabilities.