County of San Diego (B Stitt), Health and Human Services Agency, San Diego, Calif.
San Diego State University (TL Finlayson), School of Public Health, San Diego, Calif.
Acad Pediatr. 2024 Jul;24(5):791-799. doi: 10.1016/j.acap.2023.09.021. Epub 2023 Oct 4.
To examine changes in health insurance coverage when adults age out of dependent coverage at age 26 after the implementation of most Affordable Care Act (ACA) provisions. Our analysis also documented differences by sex, race and ethnicity, and state Medicaid expansion status.
We used a regression discontinuity design and the 2014-2019 American Community Survey to estimate coverage changes (uninsured, any private, employer-sponsored coverage, direct purchase, and Medicaid) at age 26. Our main sample consisted of adult citizens aged 22-29 years.
Uninsurance increased by 2.7% points [95% CI; 1.8-3.4] at age 26, which was driven by a significant decline in any private insurance (3.7% point decrease). Young adults experienced a smaller increase in the uninsured rate on turning age 26 in states that expanded in 2014 compared to nonexpansion states (2.2% and 3.2% point increases, respectively), but the difference was not significant (P = .07). Changes in the uninsured rate at age 26 did not differ significantly by sex or race and ethnicity.
The 2010 dependent coverage provision led to more coverage options among young adults and in turn the uninsured rate declined among a population historically among the most likely to lack coverage. The 2014 Medicaid and Marketplace expansions reduced the uninsured rate even further among young adults. Despite important progress, our findings for 2014-2019 were similar to previous studies using pre-ACA data suggesting that coverage loss remains a risk when adults age out of dependent coverage at age 26.
在《平价医疗法案》（ACA）大部分条款实施后，当成年人在 26 岁时脱离依赖型保险覆盖范围时，研究其医疗保险覆盖范围的变化情况。我们的分析还记录了性别、种族和民族以及州医疗补助扩展状况的差异。
我们使用回归不连续性设计和 2014-2019 年美国社区调查来估计 26 岁时的覆盖范围变化（未参保、任何私人保险、雇主赞助的保险、直接购买和医疗补助）。我们的主要样本由 22-29 岁的成年公民组成。
26 岁时未参保率增加了 2.7%点[95%可信区间：1.8-3.4]，这主要是由于任何私人保险的显著下降（下降 3.7%点）。在 2014 年扩大医疗补助范围的州，26 岁时未参保率的增长幅度小于未扩大医疗补助范围的州（分别为 2.2%和 3.2%点的增长），但差异无统计学意义（P=0.07）。26 岁时未参保率的变化在性别或种族和民族方面没有显著差异。
2010 年的依赖型保险覆盖范围规定为年轻人提供了更多的保险选择，从而使未参保率在历史上最有可能缺乏保险的人群中下降。2014 年医疗补助和市场的扩大进一步降低了年轻人的未参保率。尽管取得了重要进展，但我们 2014-2019 年的调查结果与使用 ACA 前数据的先前研究相似，这表明当成年人在 26 岁时脱离依赖型保险覆盖范围时，保险覆盖范围的损失仍然是一个风险。
