ACA Medicaid Expansion Improves Health and Increases Access to Care for Young Adults
The rate of uninsured young adults (aged 19–25) fell by more than one third between 2009 and the first quarter of 2014 following the Affordable Care Act’s (ACA’s) Medicaid expansion, according to a February 2021 report from the Urban Institute (https://www.urban.org/research/publication/impacts-acas-medicaid-expansion-health-insurance-coverage-and-health-care-access-among-young-adults/view/full_report). With the expansion, young adults also reported improved overall health, increased access to care, and fewer high out-of-pocket costs.
“Coverage gains under ACA Medicaid expansion were largest for young adults in low-income households, with notable gains for Hispanic young adults, non-Hispanic Black young adults, and young adults aged 22–25 without a college degree,” the authors said (https://www.urban.org/research/publication/impacts-acas-medicaid-expansion-health-insurance-coverage-and-health-care-access-among-young-adults/view/full_report).
Uninsurance rates and unmet care needs increased from 2016–2017 in states that did not expand Medicaid, the study results showed. Barriers to enrollment in qualifying states included lack of knowledge and concerns about affordability, but the authors theorized that targeted marketing and one-on-one enrollment assistance could mitigate them (https://www.urban.org/research/publication/impacts-acas-medicaid-expansion-health-insurance-coverage-and-health-care-access-among-young-adults/view/full_report).
“These findings suggest expanding Medicaid in additional states could further improve coverage and access to care among young adults, particularly those who are socioeconomically disadvantaged,” the report authors wrote (https://www.urban.org/research/publication/impacts-acas-medicaid-expansion-health-insurance-coverage-and-health-care-access-among-young-adults).“Our evidence implies Medicaid expansion likely improved health care access and use for young adults with lower incomes or without a college degree.”
The researchers compared trends in states that did and did not expand Medicaid under ACA using two databases: the 2011–2018 American Community Survey (ACS) for uninsurance and Medicaid coverage rates among young adults, and the 2011–2018 Behavioral Risk Factor Surveillance System (BRFSS) for trends in healthcare access and use among young adults. ACS is an annual nationwide survey from the U.S. Census Bureau, which collects social, economic, housing, demographic, health insurance coverage, and other information from more than 3.5 million households each year. BRFSS is an annual survey from the Centers for Disease Control and Prevention that assesses health behaviors, chronic conditions, healthcare access and use, and other health characteristics among adults.
Medicaid expansion coincides with earlier diagnosis rates (https://voice.ons.org/news-and-views/medicaid-expansion-coincides-with-earlier-colon-cancer-diagnosis-rates), but lack of knowledge remains a barrier to enrollment. Oncology nurses can educate patients to how to stay updated on changes to coverage (https://voice.ons.org/news-and-views/cms-changes-to-medicare-prescription-coverage-could-affect-patient-care) and enrollment requirements to encourage increased access to care.