Study Examines ACA‘s Impact on Young Adult Substance Use-Related Emergency Care
A recent study published in The American Journal of Managed Care investigated whether the affordable Care Act’s (ACA) dependent coverage expansion – allowing young adults to remain on their parents’ insurance plans until age 26 – impacted emergency department (ED) visits and hospital admissions related to substance use. Led by Refat Rasul Srejon, MPH, a Doctor of Public Health candidate at the University of Nevada, Las Vegas, the research focused on individuals aged 22-26, a demographic particularly vulnerable to substance misuse and targeted by the ACA expansion.
The study utilized a quasi-experimental design, analyzing data from the Nationwide Emergency Department Sample (NEDS) spanning 2007-2019. Researchers compared trends in ED visits and inpatient admissions for a “treatment group” of individuals aged 23-25 (directly affected by the ACA policy) with a “comparison group” of those aged 27-29 (assumed to be unaffected). Statistical adjustments were made to account for factors such as sex, pre-existing health conditions, insurance type, neighborhood income, rural location, and hospital region.
Findings revealed a notable difference in outcomes based on the substance involved. The study demonstrated a decline in alcohol-associated ED visits within the treatment group following the ACA implementation, suggesting that increased insurance coverage may have contributed to reduced emergency care for alcohol-related issues.However, opioid-associated ED visits increased and this increase was consistent across both age groups studied. Furthermore, the research found no meaningful change in inpatient admission rates related to substance use between the two age groups.
Srejon and his team interpret these contrasting results as evidence that simply expanding insurance coverage is not a thorough solution to reducing all forms of substance-related acute care utilization. The study highlights the complex interplay between insurance access and substance use disorder treatment, suggesting that additional interventions may be necessary to address the growing opioid crisis and related emergency care needs among young adults.