Changes in health insurance coverage of young adults from 2009-2010: Multilevel analysis using the medical expenditures panel survey (MEPS)

Purpose: The Affordable Care Act provision enacted on September 23, 2010 allowed young adults ages 19-25 to stay on their parent's health insurance plans. The purpose of this study was to assess the changes over time in health insurance coverage for a longitudinal cohort of nationally representative, non-institutionalized, civilian young adults ages 19-25 from 2009-2010 using MEPS data. Data and Methods: Retrospective longitudinal cohort study of nationally representative data from the Medical Expenditures Panel Survey Household Component (MEPS-HC) Panel 14 Longitudinal Data File for a cohort of 1,529 respondents who were young adults (ages 19-25). The outcome of interest included monthly indicators of having no medical or hospital insurance coverage for each respondent from 2009-2010. We used a multilevel logistic regression model to analyze the odds of not having health insurance accounting for clustering of the repeated measures within subjects. We calculated odds of no health insurance coverage among young adults across each month adjusting for age, sex, race, marital status, education, poverty level, and employment. We included a spline term for month at November 2010 to test whether there was a difference in trends before and after the ACA provision for young adults. Results: From the random-effects logistic regression, we found that the odds of not having health insurance coverage among young adults increased 1.6% per month from 2009 through 2010. Based on the Wald-test for the spline term, we did not find a significant change in trends in the odds of not having health insurance coverage among young adults before and after the ACA young adult provision during this study period from 2009 through 2010. We found significant differences in odds of not having health insurance coverage across demographic characteristics. Young adults with family income in the middle and high income groups had significantly lower odds of not having health insurance than those in the low and near poor income groups. Conclusions and Recommendations: There was an increasing monthly trend in odds of not having insurance among this young adult cohort from 2009-2010. These findings underscore the need for policymakers to implement the remaining coverage expansion in the ACA in order to protect young adults especially in low income groups whom may not have access to family health plans or public health insurance programs. Additional MEPS data releases will be required to gain a better understanding of ACA's impact on health insurance coverage among young adults.