Early Impact of the Affordable Care Act onHealth Insurance Coverage of Young Adults          AcademyHealth Annual Meeting ...
AcknowledgementsA k   l d     tSupport from State Health Access Reform Evaluation(SHARE) initiative of the Robert Wood Joh...
The Problem• Conventional dependent coverage available only to age  18 (non-students) or 23 (FT students)• Nearly 1 in 3 y...
Key Features of Dependent Coverage LK F           fD     d    C        LawsACA                                            ...
Research Questions R      hQ    ti1. What impact did the ACA dependent coverage   rules have on source of coverage among  ...
Study Data and Outcomes• Annual Social and Economic Supplement, Current  Population S  P    l ti Survey (CPS) 2005 2011   ...
Statistical Modeling• Difference-in-differences (DD) analysis of ACA coverage  outcomes      – ACA targeted vs. comparison...
DD Estimates Post-ACA Change in Coverage             Post ACAModels without ACA-state law interaction terms               ...
DD Estimates Post-ACA Change in Coverage             Post ACAModel with ACA-state law interaction terms                   ...
LimitationsLi it ti• Current Population Survey            p             y      – Annual recall period, cannot observe timi...
Conclusions & Implications• Rapid and substantial increase in dependent coverage      – 25% increase in dependent coverage...
Conclusions & Implications ( ti d)                           (continued)• If SCOTUS strikes down the ACA      – Tax conseq...
Thank You                                      jcantor@ifh.rutgers.eduRelated PublicationsMonheit AC, JC Cantor, D DeLia, ...
• Extra slidesCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research
Sensitivity TestsS   iti it T t• Non reform states only  Non-reform• Placebo model (Test for ACA “impact” in 2009)        ...
State Young Adult Dependent CoverageLaws Implementation Timeline31 states as of 2010Original implementation shown in black...
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2012 arm cantor

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2012 arm cantor

  1. 1. Early Impact of the Affordable Care Act onHealth Insurance Coverage of Young Adults AcademyHealth Annual Meeting June 25, 2012 Orlando, FL Joel C. Cantor ScD, Professor and Director Alan Monheit PhD, Professor* Derek DeLia PhD, Associate Research Professor Kristen Lloyd MPH, Research Analyst Rutgers Center for State Health Policy *UMDNJ School of Public Health
  2. 2. AcknowledgementsA k l d tSupport from State Health Access Reform Evaluation(SHARE) initiative of the Robert Wood Johnson FoundationWeW are grateful for the contributions of … t f l f th t ib ti f Dina Belloff, Margaret Koller, and Dorothy Gaboda of Rutgers CSHP Lynn Blewett, SHARE director and the SHARE project team y , p j Brian Quinn, RWJF Senior Program OfficerCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 2
  3. 3. The Problem• Conventional 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• C Compared t i d to insured peers, uninsured young adults are d i d d lt – 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 critical developmental period to address obesity, smoking, sexually transmitted infections, etc.• Absence from risk pools has consequences for othersCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 3
  4. 4. Key Features of Dependent Coverage LK F fD d C LawsACA State Laws• First renewal starting 9/23/10 • 31 states, most 2006-09• All young adults to 26 • Age limits vary, max 31• No residency, demographic, • Typically limited to or other exclusions unmarried, no dependents, in-state except FT students; some require financial dependency• Applies to all plans, including • Do not apply to self-insured self insured self-insured plans• No cost beyond standard • Nine require or allow added family premium premiumCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 4
  5. 5. Research Questions R hQ ti1. What impact did the ACA dependent coverage rules have on source of coverage among eligible young adults?2.2 What impact did the rules have among young adults targeted by prior state laws in addition to the ACA?Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 5
  6. 6. Study Data and Outcomes• Annual Social and Economic Supplement, Current Population S P l ti Survey (CPS) 2005 2011 (CPS), 2005-2011• Study population – ACA targeted: ages 19-23 not FT students & all ages 24-25 19 23 24 25 – Comparison group: Ages 27-30 – Exclude age=26 and MA & HI (due to prior mandates)• O Outcomes: S Sources of coverage at any time during year f i d i 1. Private non-spousal dependent coverage 2. Private coverage in own name or as dependent of a spouse g p p 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 6
  7. 7. 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 – St t fixed effects, overall trend, state-specific t d State fi d ff t ll t d t t ifi trends – State-year unemployment, ESI offer, enrollees in self-insured plans• Sensitivity tests y – Can discuss in Q&A if timeCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 7
  8. 8. DD Estimates Post-ACA Change in Coverage Post ACAModels without ACA-state law interaction terms 10.0 Percentag Point Change 8.0 6.0 5.3* 4.0 40 C 2.0 0.6 0.0 ge 20 -2.0 + -4.0 -2.1 -3.5* -6.0 -8.0 -8 0 P -10.0 Private Private Self or Public Uninsured Non-Spouse Spouse Dependent * p<0.001; + p<0.05Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research
  9. 9. DD Estimates Post-ACA Change in Coverage Post ACAModel with ACA-state law interaction terms Targeted by ACA and State Law Targeted by ACA only 10.0 8.7* hange 8.0 6.0 *, a 4.5 ercentage Point Ch 4.0 2.0 1.2 0.5 0.0 e -2.0 -0.6 -4.0 -2.0 +, b -3.8 -6.0 Pe -8.0 + -10.0 -8.3 Private Private Self or Public Uninsured Non-Spouse p Spouse p 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
  10. 10. LimitationsLi it ti• Current Population Survey p y – Annual recall period, cannot observe timing of coverage changes – For YAs in separate households, lacks info on parent insurance status, residency, other characteristics – Imprecise state policy target variable• Short post-implementation observation period (Q4 2010) – Some respondents may report through Q1 2011Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 10
  11. 11. 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• Possibly greater impact on state-targeted young adults – “Pump priming” effect?• E Expected intended and unintended i t d i t d d d i t d d impacts t – Improved access to care – Higher private family premiums – Shift young people out of exchange risk pools – Extend dependency further into adulthoodCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 11
  12. 12. Conclusions & Implications ( ti d) (continued)• If SCOTUS strikes down the ACA – Tax consequences – Separate premiums may be charged – Exclusions possible ( g , married y p (e.g., young adults) g )Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 12
  13. 13. 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, Belloff,C t JC D B ll ff AC Monheit, D DeLia, & M Koller. 2012 “E M h it D Li K ll 2012. “Expanding ddi dependent coverage f young d t for 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.Analysis April 2010 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 expansionswww shadac org/publications/share-webinar-April2010-dependent-coverage-expansionsCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 13
  14. 14. • Extra slidesCenter for State Health PolicyInstitute for Health, Health Care Policy and Aging Research
  15. 15. Sensitivity TestsS iti it T t• Non reform states only Non-reform• Placebo model (Test for ACA “impact” in 2009) impact• Models w/o student status and with FT students 19-23Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research 15
  16. 16. 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 16

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