Aging Out of Dependent Coverage and Health Insurance Trends, 2014-2019

Area of Science:

• Health Services Research
• Public Health Policy
• Health Economics

Background:

• The Affordable Care Act (ACA) introduced provisions like dependent coverage to improve health insurance access for young adults.
• Young adults historically face high rates of uninsurance, particularly upon aging out of parental coverage.
• Understanding coverage transitions at age 26 is crucial for evaluating ACA's impact and identifying remaining gaps.

Purpose of the Study:

• To analyze changes in health insurance coverage for adults transitioning off dependent coverage at age 26.
• To investigate how Affordable Care Act (ACA) provisions influenced these coverage changes.
• To examine disparities in coverage transitions by sex, race/ethnicity, and state Medicaid expansion status.

Main Methods:

• Utilized a regression discontinuity design with American Community Survey data (2014-2019).
• Focused on adult citizens aged 22-29 years to estimate coverage changes at age 26.
• Assessed transitions into uninsured, private, employer-sponsored, direct purchase, and Medicaid coverage.

Main Results:

• A 2.7% point increase in uninsurance was observed at age 26, primarily due to a 3.7% point decrease in private insurance.
• Coverage loss at age 26 was slightly less pronounced in states that expanded Medicaid in 2014, though not statistically significant.
• No significant differences in uninsurance rate changes were found based on sex or race and ethnicity.

Conclusions:

• The ACA's dependent coverage provision initially improved young adult insurance rates.
• Subsequent Medicaid and Marketplace expansions further reduced uninsurance among this demographic.
• Despite progress, coverage loss at age 26 remains a persistent risk, similar to pre-ACA trends.