Funded Projects

(SDAS) Health Insurance and Access to Care Among Young Adults with Disabilities

Grantee: University of Missouri-St. Louis
Principal Investigator: Shirley Porterfield
Project Number: R40MC28311
Project Date: 04/01/2015

Age group(s)

• Young Adulthood (19-25 years)

Abstract

Young adults (ages 19 to 23) have long had the highest risk of uninsurance, with over 30% uninsured prior to passage of the Affordable Care Act (ACA). Pre-ACA health insurance options were limited for transition-age young adults, and young adults with disabilities were less likely than their non-disabled peers to remain as dependents on their parents' family coverage as fulltime college students, or to work at a job where health insurance benefits were offered. One of the first implemented provisions in ACA allowed young adults to remain on their parents' private health insurance plans until their 26th birthday, even if they were not full time students. While there has been some analysis of the impact of this dependent coverage provision for all young adults, there has been no nationally-representative examination of the impacts of this provision or of the fully implemented ACA on young adults with disabilities. The purpose of this study is to investigate the impact of the ACA on young adults with disabilities (ages 19 to 23), looking at three distinct time periods: pre-ACA (2006-2009), post- ACA but pre-full implementation (2011-2013), and post-full implementation of the ACA (2014- 2015). The National Health Interview Survey (NHIS) annual files for 2006 to 2015 will be used for this project. Our empirical approach will include descriptive analysis and the estimation of multivariate models that take into account age group, disability status, time period, and income, while controlling for demographic, usual source of care, and family characteristics. Goals of the ACA were to increase secure and affordable health insurance coverage, improve healthcare access for the uninsured, lower out-of-pocket costs, and improve health through better prevention and management of chronic conditions and disabilities. Although this study will not examine the last ACA goal, improved health, meeting the first three goals will likely, in the long run, lead to improved health status among young adults with disabilities. This research will help determine whether or not the ACA goals are being met for young adults with disabilities overall and, if not, will help identify characteristics of young adults with disabilities who still face barriers to health care access and/or high health care costs. Results from this study will help inform both researchers and policy makers about the specific elements of the ACA that are helpful in easing the transition from pediatric to adult health care systems as children with special health care needs (CSHCN) become young adults with disabilities. Uncoupling health insurance from both employment and from the social welfare system should remove barriers to access to care for young adults with disabilities as well as reducing health disparities created by differences in family resources and age.

Publications

Listed is descending order by year published.

Huang J, Porterfield SL. Changes in health insurance coverage and health care access as teens with disabilities transition to adulthood. Disabil Health J. 2019. 12 (4) 551-556.

Porterfield SL, Huang J. Affordable Care Act provision had similar, positive impacts for young adults with and without disabilities. Health Aff (Millwood). 2016;35(5):873-879.