insurance; affordable care acrt


Other Medical Sciences | Public Health | Translational Medical Research


Background. A goal of expanding insurance coverage is reducing racial disparities in healthcare utilization, however the effects of such expansions under the affordable care act (ACA) on disparities remain unclear. The 2010 dependent coverage expansion provided an opportunity to evaluate disparities following a major coverage expansion.

Objectives. We sought to understand changes in emergency department (ED)utilization following a major insurance expansion, the 2010 dependent coverage expansion.

Research Design. We present changes in coverage and utilization among young adults (19-25 years old) before and after the dependent coverage expansion, compared to a control group (26-31 years old) unaffected by the provision using administrative records from four states (California, Florida, Massachusetts and New York) using a difference in difference methodology.

ResultsWe identified 9,089,116 adults aged 19-31 with at least one ED visit between 2008 and 2013. While rates of ED utilization continue to increase, we found dependent coverage expansion was associated with a reduced increase in adjusted ED utilization among Whites, Blacks, and Asians (p

Conclusions. Expansion of dependent insurance coverage was associated with significantly different ED healthcare utilization patterns among Hispanics than among other young adults. This suggests that eligibility or accessibility of dependent coverage remains a barrier to care for young Hispanics.