Online Program

Changes in Racial Disparities for Emergency Department Utilization Among Young Adults After the Affordable Care Act's Dependent Coverage Expansion

Monday, November 2, 2015 : 11:30 a.m. - 11:50 a.m.

Tina Hernandez-Boussard, PhD, MPH, MS, Departments of Surgery and Medicine, Stanford University, Stanford, CA
Doug Morrison, MS, Department of Surgery, Stanford University, Stanford, CA
Sanjay Basu, MD, PhD, Stanford University, Department of Medicine, Stanford, CA
Background: Although young adults are a generally healthy population, they account for a substantial proportion of emergency department (ED) visits and often lack health insurance. The 2010 Affordable Care Act (ACA) was designed to improve health care for all Americans and reduce disparities; it included a provision to allow young adults ages 19–25 to remain as dependents on their parents’ private insurance policies. This provision appears to have increased insurance coverage and reduced ED utilization among young adults. However, since it is contingent on parents’ insurance status, it may differentially benefit racial/ethnic groups.

 Methods: To characterize changes in race/ethnic disparities in ED utilization among young adults before and after the ACA, we used 2009-2011 administrative records from California, Florida, and New York tracking all ED visits by race/ethnicity and age. The ACA’s effect on ED utilization was estimated using a difference-in-differences approach between adults aged 19-25 and those aged 26-31. To account for ED utilization time-trends, a microsimulation approach was used that estimated the counterfactual change in ED visits in the absence of the ACA. Disparities were measured via the between-group variance (BGV), an absolute disparity measure.

 Results: The ACA differentially affected ED visit rates per person by race/ethnicity, with the greatest relative change among blacks  (-2.1%; 95%CI: -2.9, -1.2), followed by whites (-1.4%; 95%CI: -2.0, -0.8), and Hispanics (-1.0%; 95%CI: -0.9, 0.7), consistent with the idea that parental insurance status influenced dependent utilization. However, absolute disparities did not change significantly when accounting for uncertainty and variation among groups using a microsimulation approach (ΔBGV= -1.8; 95%CI: -3.7, 0.2; p=0.069).

Conclusions: The ACA’s dependent coverage expansion was associated with reduced ED utilization for some young adults more than others, but during the first year of implementation the overall absolute disparities in ED visits were not significantly changed across race/ethnic groups.

Learning Areas:

Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe how the Affordable Care Act Dependent Coverage Expansion affects racial disparities in emergency department utilization among young adults.

Keyword(s): Health Disparities/Inequities, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been lead author of multiple publications focusing on the effect of the ACA on emergency department utilization among young adults. Among my scientific interests is how the ACA has changed racial disparities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.