Young Adult ED Use Decreased Under ACA Provision

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Extending young adults' eligibility for health insurance on their parents' plans under an Affordable Care Act provision led to a decrease in emergency department visits.

Extending young adults’ eligibility for health insurance on their parents’ plans under an Affordable Care Act (ACA) provision led to a decrease in emergency department (ED) visits, according to a new study in Health Affairs.

The authors compared ED use from 2009 to 2011 in young adults aged 19 to 25 years old with patients between the ages of 26 and 31 years, who were not eligible for parental insurance under the ACA. They used state administrative records from in California, Florida, and New York.


Compared to the older group, the 19- to 25-year-olds had a decrease of 2.7 ED visits per 1,000 people. Women and blacks reported the largest relative decreases (-3% and -3.4%, respectively). According to the researchers, the change in number of visits was driven by fewer visits by ED users because they found only a -0.4% decrease among the younger group when comparing the probability of ever using the ED before and after the ACA provision was implemented.

“This relative decrease in ED use implies a total reduction of more than 60,000 visits from young adults ages 19—25 across the three states in 2011,” the authors wrote.

The younger age group also reported a 2.9% reduction in self-pay patients, while the older group only had a 0.6% decrease.

The authors suggest that expanding ACA coverage to other populations could continue to reduce ED use. However, despite their findings, they do not actually confirm a link between the ACA provision and ED use.

“Our results do not provide evidence about the mechanism that generated the observed changes,” they wrote. “However, it is plausible that the ACA played a causal role. Both our results and other reports suggest that the ACA provision was associated with higher rates of insurance coverage among young adults ages 19—25.”