Impact of state laws that extend eligibility for parents' health insurance coverage to young adults

Abstract

Background and objectives: The 2010 Affordable Care Act mandates that health insurance companies make those up to age 26 eligible for their parents' policies. Thirty-four states previously enacted similar laws. The authors sought to examine the impact on access to care of state laws extending eligibility of parents' insurance to young adults.

Methods: By using a difference-in-differences analysis, we examined the 2002-2004 and 2008-2009 Behavior Risk Factor Surveillance System to compare 3 states enacting laws in 2005 or 2006 with 17 states that have not enacted laws on 4 outcomes: self-reported health insurance coverage, identification of a personal physician/clinician, physical exam from a physician within the past 2 years, and forgoing care in the past year due to cost.

Results: For each outcome there was differential improvement among states enacting laws compared with states without laws. Health insurance differentially increased 0.2% (95% confidence interval [CI], -3.8% to 4.2%), from 67.6% to 68.1% pre-post in states enacting laws and from 68.5% to 68.7% in states without. Personal physician/clinician identification differentially increased 0.9% (95% CI -3.1% to 5.0%), from 62.4% to 65.5% in states enacting laws and from 58.0% to 60.2% in states without. Recent physical exams differentially increased significantly 4.6% (95% CI, 0%-9.2%), from 77.3% to 81.2% in states enacting laws and from 76.2% to 75.5% in states without. Forgone care due to cost differentially decreased significantly 3.9% (95% CI, -0.3% to -7.5%), from 20.4% to 18.2% in states enacting laws and from 17.8% to 19.4% in states without.

Conclusions: States that expanded eligibility to parents' insurance in 2005 or 2006 experienced improvements in access to care among young adults.

FIGURE 1

State insurance eligibility extension legislation among the 50 states and the District of Columbia. Control states were compared with the intervention states both with and without the inclusion of Massachusetts (which enacted legislation in 2006), because eligibility extension in Massachusetts was part of a larger health care reform law that included an insurance coverage mandate.