Pattern and Characteristics of Health Insurance Coverage Among Young Adults Under the Affordable Care Act

Background and Purpose

Affordable Care Act (ACA) expanded the age of eligibility for dependent coverage under a parents’ private health insurance plan until they turned 26 years old. Recent research has shown that the dependent coverage expansion played an important role in increasing the number of insured young adults. Few studies, however, have examined the longitudinal pattern of health insurance coverage among young adults. Little is known about the characteristics of young adults enrolled through this expansion and of those remained un-insurance. Furthermore, relatively few studies have either investigated why some young adults signed up under their parents insurance, and others did not. By addressing these gaps in research, the proposed study aims to (1) examine the pattern of health insurance coverage among young adults between 2008 and 2013; (2) examine which young adults benefit from the ACA expansion and who are at risk without health insurance; (3) investigate the reasons why young adults have no health insurance coverage.

Methods

The 2008 panel (Wave 1-Wave 16) of the Survey of Income and Program Participation was used in this study. The sample included young adults who are between 19 and 25 years old and had a family income below 200% of the federal poverty line at the baseline. Lack of health insurance was measured by the number of months without any health insurance during 64 months. Weighted descriptive statistics was calculated to examine patterns of monthly health insurance coverage, characteristics of young adults without health insurance, and reasons for not being covered by health insurance. Multivariate regression models were used to identify characteristics associated with health insurance coverage expansion and lack of health insurance.

 

Results

Results indicate that health insurance coverage among young adults has increased from 2008 to 2013, through dependent coverage expansion, Medicaid expansion, and Marketplaces. Men, white, older young adults (aged 23-25), those with high and moderate income, and college graduates benefits from dependent coverage expansion. However, a substantial number of young adults were at high risk of lack of health insurance. Young adults who experienced more months without health insurance were Hispanic, female, non-US citizens, more older, less educated, lived in South, received public benefits, and had lower family income, compared to their counterparts. Furthermore, reasons for not having health insurance were parents with no employer-provided insurance coverage, not offered by employer, not eligible because of part-time job, ineligible for public health insurance, and high cost of premiums.

Conclusions and Implications

            Results highlight vulnerability of young adults to experiencing multiple months without health insurance coverage, and identify characteristics of those at high risk of lack of health insurance. Findings suggest the need for practitioners to assist young adults in obtaining employment and accessing to health insurance. Results can inform social policy and strategy-related interventions to target young adults with high risk of lack of health insurance and to provide additional economic support and employment related services for them. Moreover, the findings suggest the need for continuing social policies that increase more universal access to health care insurance.