Online Program

Behavioral Health Care Expenditures and Disparities under the ACA Dependent Coverage Expansion

Monday, November 2, 2015 : 3:15 p.m. - 3:30 p.m.

Mir Ali, PhD, Substance Abuse & Mental Health Services Administration, Rockville, MD
Jie Chen, PhD, Department of Health Services Administration, School of Public Health, University of Maryland, College Park, College Park, MD
Ryan Mutter, PhD, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
Priscilla Novak, Health Services Administration, University of Maryland, College Park, MD
Background: In 2010, the Affordable Care Act (ACA) extended eligibility for dependent coverage under private health insurance, allowing children to continue on family plans up to age 26.


Objective: The objective of this study is to estimate health care expenditures and racial and ethnic disparities in health care expenditures among young adults with behavioral health disorders before and after the implementation of the ACA in 2010.


Methods: Using 2008-2012 nationally representative data from Medical Expenditure Panel Survey, we employed a difference-in-difference model to estimate the trends of health care expenditure among young adults ages 19-26 and ages 27-29 (the comparison group), with diagnosed behavioral health disorders. We also examined the variation of health care expenditures by race and ethnicity among those with behavioral health disorders.


Results: Among populations with behavioral health disorders, our results showed that young adults ages 19-26 had significantly lower out of pocket health care expenditures under the ACA expansion on dependent coverage, compared to their counterparts ages 27-29. In addition, the results show that this reduction in out of pocket expenses was larger among the Hispanics compared to non-Hispanic Whites and African Americans.


Policy implications: Our findings suggest ACA’s dependent coverage provision had a significant impact on improving behavioral health coverage and reducing health expenditures. An integrated behavioral health system and better care coordination with general medical care might be effective to further improve behavioral health. 


Learning Areas:

Administration, management, leadership
Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Evaluate and assess the impact of the Affordable Care Act on behavioral health care expenditure of young adults.

Keyword(s): Affordable Care Act, Youth

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I lead the Health Economics and Financing Team (HEFT) in the Center for Behavioral Health Statistics and Quality (CBHSQ) at the Substance Abuse and Mental Health Services Administration (SAMHSA). I have been the author of numerous publications on the association between health insurance status and health services utilization for individuals with behavioral health conditions.
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.