• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
2012 armshrpig delia
 

2012 armshrpig delia

on

  • 392 views

 

Statistics

Views

Total Views
392
Views on SlideShare
323
Embed Views
69

Actions

Likes
0
Downloads
1
Comments
0

2 Embeds 69

http://www.shadac.org 68
http://shadac.org 1

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    2012 armshrpig delia 2012 armshrpig delia Presentation Transcript

    • Early Impact of the Affordable Care Act onHealth Insurance Coverage of Young Adults AcademyHealth State Health Research and Policy Interest Group Meeting June 23, 2012 Orlando, FL Joel C. Cantor, ScD; Alan Monheit, PhD, Derek DeLia, PhD, and Kristen Lloyd, MPH Rutgers University Center for State Health Policy and UMDNJ School of Public Health (Monheit)
    • AcknowledgementsSupport from State Health Access Reform Evaluation(SHARE) initiative of the Robert Wood Johnson FoundationWe are grateful for the contributions of … Dina Belloff, Margaret Koller, and Dorothy Gaboda of Rutgers CSHP Lynn Blewett, SHARE director and the SHARE project team Brian Quinn, RWJF Senior Program OfficerCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 2
    • Outline1. The young adult (YA) coverage problem2. Recent policy responses – Federal – State3. Findings on the impact of federal reforms on coverage – How federal reforms interact w/prior state reforms4. ImplicationsCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 3
    • The Problem• Historically, dependent coverage available only to age 18 (non-students) or 23 (FT students)• Nearly 1 in 3 young adults (age 19-25) uninsured in 2009• Compared to insured peers, uninsured young adults are – More likely to delay or forego care due to costs – Less likely to see a medical provider, have a usual source of care, or fill a prescription – More likely to have trouble paying medical bills or medical debt• Implications for health behaviors and LT health status• Absence from risk pools has consequences for othersCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 4
    • YA Dependent Coverage under Federal ACA • YAs (< 26) can enroll as dependents in parents’ plan • All private plans with family coverage • Effective with first renewal starting Sept. 23, 2010 • Non-discrimination, same benefits, no added premium for family plans • “Grandfathered” plans exempted only if young adults are offered own employer plan and only until 12/2013 • Descriptive evidence of high take up – Drop of 2.5 million uninsured young adults from 9/2010 to 6/2011 – Consistent with anecdotal reports and employer survey findings Center for State Health Policy Institute for Health, Health Care Policy and Aging Research 5
    • State Young Adult Dependent CoverageLaws Implementation Timeline31 states as of 2010Original implementation shown in blackExpanded implementation shown in blue italics DE FL ID IN ME FL CT MA IA IL NH KT LA RI MD NJ SD MN NY ND CO VA MO PA OH UT NM TX SD NJ WV MT WA WI 1995 2003 2004 2005 2006 2007 2008 2009 2010Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 6
    • Key Features of Dependent Coverage LawsFederal ACA State Laws• First renewal starting 9/23/10 • Most in 2006-09• All young adults to 26 • Age limits vary, max to 31• Eligibility by age only • Typically limited to unmarried, no dependents, in-state except FT students; some require financial• Applies to all plans, including dependency self-insured • Do not apply to self-insured• No addition to standard family plans (ERISA) premium • Nine allow or require added premiumCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 7
    • Research Questions1. What impact did the ACA dependent coverage rules have on source of coverage among eligible young adults (YAs)?2. What impact did the rules have among young adults (YAs) targeted by prior state laws in addition to the ACA?Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 8
    • Study Data and Outcomes• Current Population Survey (CPS), Survey years 2005-2011; CYs: 2004-2010• Study population – ACA targeted: ages 19-23 not FT students & all ages 24-25 – Comparison group: Ages 27-30 – Exclude age=26 and MA & HI (due to prior mandates)• Outcomes: Sources of coverage at any time during year 1. Private non-spousal dependent coverage 2. Private coverage in own name or as dependent of a spouse 3. Public (Medicaid, Medicare, etc.) 4. No coverage• Coverage categories not mutually exclusiveCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 9
    • Statistical Modeling• Difference-in-differences (DD) analysis of ACA coverage outcomes – ACA targeted vs. comparison – Pre/post ACA• Extended DD analysis interacting ACA and state policies – State targeted vs. non-state targeted – Federal & state policy interactions• Four linear probability models, controlling for – Demographics, SES, student status, live@home, health status – State fixed effects, overall trend, state-specific trends – State-year unemployment, ESI offer, enrollees in self-insured plans• Sensitivity tests – Similar results ==> robust findingsCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 10
    • DD Estimates Post-ACA Change in CoverageModels without ACA-state law interaction terms 10.0 Percentage Point Change 8.0 5.3 * 6.0 4.0 2.0 0.6 0.0 -2.0 + -4.0 -2.1 -3.5* -6.0 -8.0 -10.0 Private Non- Private Self or Public Uninsured Spouse Spouse Dependent * p<0.001; + p<0.05Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research
    • DD Estimates Post-ACA Change in CoverageModel with ACA-state law interaction terms Targeted by ACA and State Law Targeted by ACA only 10.0 8.7* Percentage Point Change 8.0 6.0 *, a 4.5 4.0 2.0 1.2 0.5 0.0 -2.0 -0.6 -4.0 -2.0 +, b -3.8 -6.0 -8.0 + -10.0 -8.3 Private Non- Private Self or Public Uninsured Spouse Spouse Dependent * p<0.001; + p<0.05Center for State Health Policy abetween group difference p=0.068Institute for Health, Health Care Policy and Aging Research bbetween group difference p=0.173
    • Limitations• Current Population Survey – Annual recall period – Cannot observe timing of coverage changes – Cannot link information about YAs living in separate households – Imprecise state policy target variable• Short post-implementation observation period (2010-Q4) – Some respondents may report through 2011-Q1Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 13
    • Conclusions & Implications• Rapid and substantial increase in dependent coverage – 25% increase in dependent coverage & near 10% drop in uninsured – Over 700,000 uninsured Æ dependent coverage due to ACA• Partial decline in own-name/spousal coverage – Our earlier research showed full substitution under state reforms – CPS would not show within year ↓ in private coverage – Other factors?• Possibly greater ACA impact on state-targeted YAs – Hypothesis: “Pump priming” effectCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 14
    • Conclusions & Implications (continued)• Additional longer term implications – Improved access to care – Higher private family premiums – Fewer YAs in exchanges ==> greater average risk – Extend dependency further into adulthoodCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 15
    • Thank You jcantor@ifh.rutgers.eduRelated PublicationsMonheit AC, JC Cantor, D DeLia, & D Belloff. 2011. “How have state policies to expand dependent coverage affected the health insurance status of young adults?” Health Service Research 46 (1 pt 2): 251-67.Cantor JC, D Belloff, AC Monheit, D DeLia, & M Koller. 2012. “Expanding dependent coverage for young adults: lessons from state initiatives.” Journal of Health Politics, Policy, and Law 37(1): 99-128.SHARE BriefsDependent Coverage Expansions: Estimating the Impact of Current State Policies. January 2010.www.shadac.org/files/shadac/publications/DependentCoverageExpansionsIssueBrief.pdfThe Impact of State Dependent Coverage Expansions on Young Adult Insurance Status: FurtherAnalysis. April 2010.www.shadac.org/files/shadac/publications/DependentCoverageCompanionBrief.pdfWebinar: The Impact of Extending Dependent Insurance Coverage to Young Adults. April 2010.www.shadac.org/publications/share-webinar-April2010-dependent-coverage-expansionsCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 16
    • Sensitivity Tests• Non-reform states only• Placebo model (Test for ACA “impact” in 2009)• Models w/o student status and with FT students 19-23Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 17