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The Affordable Care Act: Disparities in Emergency Department and Hospital Use for Mental Health Diagnoses In Young Adults

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Abstract

One of the first provisions of the Affordable Care Act to be implemented allowed young adults to remain on their parents' insurance plans until the age of 26. This study estimated the association between the dependent coverage provision and changes in young adults’ usage of Emergency Department (ED) and Hospital services for psychiatric diagnoses. We utilized a Quasi-Experimental Analysis of ED use and inpatient admissions in California from 2009-2011 for behavioral health diagnosis of individuals aged 19 to 31-years old. Analyses used a difference-in-differences approach comparing those targeted by the ACA dependent provision (19 to 25-year-olds) and those who were not (27 to 31-year-olds), evaluating changes in ED/Inpatient visit rates per 1,000 in California. Primary outcome measures included the quarterly ED/Inpatient visit rates with any psychiatric diagnosis, with subgroup analysis looking at the effects of race and gender on the primary outcome. It was found that while the young adult dependent provision was associated with 0.05 per 1,000 people (p<0.001) fewer psychiatric ED visits among the treatment group (19 to 25-year-olds) compared to the control group (27 to 31-year-olds), this significant reduction in psychiatric ED visits was not seen in males, hispanics, asians or pacific islanders. Furthermore, hispanics, asians, and pacific islanders were the only racial subgroups that did not see gains in the proportion of psychiatric ED visits covered by private insurance. Additionally, inpatient visit rates did not significantly change in the treatment group relative to the control group, however after stratification, rates significantly increased for males, whites, blacks, and mixed/other racial groups. While the source of admission from the ED did not significantly change in the treatment compared to the control group, admissions from sources other than the ED significantly increased overall, as well as for whites, blacks, mixed/other, and females. Ultimately, our research has shown that in one of the earliest aspects of the ACA, gender, and racial disparities exist.

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