Racial/Ethnic Variation in the Impact of the ACA on Insurance Coverage and Access Among Young Adults Aurora (Rory) VanGarde Carolyn Mendez-Luck Jangho Yoon Jeff Luck OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
ACA Provisions Intended to Expand Insurance Access for Young Adults • 2010 ACA- allowed young adults ages 19-25 to remain on parental insurance. • In 2009, Hispanic and black individuals aged 18-24 were less likely to be insured compared to white individuals of the same age (Demos, 2011). • People of color are at disproportionate risk of being uninsured and of lower income (Kaiser Family Foundation, 2013). • By 2011, of young adults who had parental insurance, 13.1% still remained uninsured (Antwi et al., 2013). OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Young Adult Health Insurance Improved with ACA 40 35 30 Percent Insured 25 20 Young Adults Adults 15 10 5 0 2007-2009 2011 Year Busch, Golberstein & Meara, 2014) OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Objective: Examine Impact of ACA on Young Adult Insurance by Race/Ethnicity • Examine disparities among young adults before and after ACA implementation. • Measure impact of ACA implementation on outcomes of: o Health insurance coverage o Deterring necessary health care visits due to cost • Quantify variation in impacts across racial/ethnic groups. OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Methods • Difference-in-differences (DID) • ACA lends itself as a natural experiment, with part of the population (young adults) acting as the experimental group, and adults not impacted act as the comparison group. o If the 2010 ACA implementation impacting young adults had not occurred, the assumption is that the trend of young adults health insurance and access to providers would continue as previously, and remain comparable to adults. • Behavioral Risk Factor Surveillance System Annual Surveys (BRFSS) o 2007-2009; 2011-2013 o 402,777 observations • 121,523 Young Adults (ages 19-25): Policy/Treatment Group • 281,254 Adults (ages 26-35): Comparison Group OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Percent Health Insurance Rates, Young Adult and Adult 0.8 0.78 Mean Health Inusrance 0.76 0.74 0.72 0.7 Adults 0.68 Young Adults 0.66 0.64 0.62 0.6 2007 2008 2009 2010 2011 2012 2013 Year OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Percent Cost Issue, Young Adult and Adult 0.25 0.2 Mean Percent Cost Issue 0.15 Adults 0.1 Young Adults 0.05 0 2007 2008 2009 2010 2011 2012 2013 Year OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Percent Health Insurance for Young Adults by Race 0.95 0.9 White 0.85 Mean Health Insurance Black 0.8 0.75 Asian 0.7 Hawaiian 0.65 American Indian or 0.6 Alaskan Native Other non-Hispanic 0.55 Multirace, non-Hispanic 0.5 0.45 Hispanic 0.4 2007 2008 2009 2010 2011 2012 2013 Year OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Impact of ACA ’s Coverage Extension on Health Insurance Coverage and Avoided Health Care Services Due to Cost Issues by Race/Ethnicity Change in Health Insurance Change in Avoid Health Care Race/Ethnicity Coverage (%p) Services Due to Cost (%p) *** (.30) ‒ 3.21 *** (.28) White 7.05 * (.61) ‒ 0.08 (.58) Black 1.18 *** (.52) *** (.48) ‒ 1.72 Hispanic 6.09 *** (.92) ‒ 2.59 *** (.81) Asian 4.61 *** (1.21) ‒ 3.33 *** (1.07) Hawaiian/Pacific Islander 5.08 American Indian/Alaskan *** (.13) ‒ 2.44 * (1.13) 8.43 Native * (1.85) 0.28 (1.86) Other non-Hispanic 4.09 *** (.92) *** (.90) ‒ 3.06 Multiple Race, non-Hispanic 4.74 Notes: %p = percentage point. Standard errors are in parentheses. Estimates are survey-weighted and standard errors are adjusted for a complex survey design of BRFSS. * p < .05; ** p < .01; *** p < .001. OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Young Adult Health Insurance Increased, Disparity Remained • Insurance rates for all young adults increased by 6.12 percentage points. • Compared to whites, all other racial/ethnic groups less likely to be insured. • Persons who were employed or students, higher education and income, married or having children, female, good health and chronic conditions more likely to be insured. OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Cost Issues Improved Overall, For Some More than Others • Skipping necessary care due to costs decreased by 2.61 percentage points for young adults post ACA, increased for adults. o Over all time periods combined, Asians and American Indians/Alaska Natives were less likely to skip necessary care due to cost than whites, but most other racial/ethnic groups were more likely to skip care. • Persons who were employed, higher education or income, married, better health status were less likely to skip care. • Females and persons with asthma or diabetes were more likely to skip care. OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Conclusions • Uninsured rates dropped after ACA. o However, only young adults whose parents were insured were able to take advantage. • Young adults insurance rates remained 0.77 percentage points lower than adults after the ACA. • Hispanics, American Indians/Alaska Natives, and Hawaiian/Pacific Islanders had lower than average rates of insurance before the ACA, but these disparities were somewhat mitigated by relatively large increases in coverage after ACA implementation. OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Limitations • This research did not discern between types of insurance, only if insured or uninsured. • Cannot link as to why uninsured- unknown if insurance is available from parent or employer, or Medicaid. • Of those who had insurance- unknown if it was from parental insurance or obtained on their own. OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Policy Implications • The 2010 ACA extension of parental insurance significantly increased the number of young adults having health insurance, but racial and ethnic disparities persisted. • These findings suggest that mitigating racial and ethnic disparities should be an explicit consideration when developing national health insurance reform policy. OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
Thank you for your time. Rory VanGarde aurora.vangarde@oregonstate.edu OREGON STATE UNIVERSITY | COLLEGE OF PUBLIC HEALTH AND HUMAN SCIENCES
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