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Insurance Coverage and Health Outcomes in Young Adults With Mental Illness Following the Affordable Care Act Dependent Coverage Expansion
Abstract
OBJECTIVE: As a provision of the Affordable Care Act, young adults were able to remain on their parents' health insurance plans until age 26. We examined the impact of the 2010 dependent coverage expansion on insurance coverage and health outcomes among young adults with mental illness. METHODS: Data are from the 2008-2013 National Survey on Drug Use and Health, an annual population-based survey of noninstitutionalized US individuals aged 12 and older. We used a difference-in-differences approach to compare young adults with mental illness subject to the provision (aged 19-25 years, n = 19,051) with an older comparison group (aged 26-34 years, n = 7,958) before (2008-2009) and after (2011-2013) the dependent coverage expansion in their insurance coverage, use of health services, and self-reported health. RESULTS: In adjusted analyses, following the dependent coverage expansion, private insurance coverage increased by 11.7 percentage points (95% CI, 8.4-15.1, P < .001) and uninsurance decreased by 8.9 percentage points (95% CI, -12.1 to -5.7, P < .001) among 19- to 25-year-olds with mental illness, relative to 26- to 34-year-olds. The provision was associated with a modest increase in young adults with mental illness who received outpatient mental health treatment at least monthly on average (+2.0% [95% CI, 0.1% to 4.0%, P = .04]) and a modest decrease in those reporting their overall health as fair or poor (-2.3% [95% CI, -4.6% to -0.0%, P = .05]). Unmet mental health needs due to cost decreased significantly among those with moderate-to-serious mental illness (-12.3% [95% CI, -22.7% to -2.0%, P = .02]), but did not change among those with mild illness. CONCLUSIONS: The 2010 dependent coverage expansion was associated with an increase in insurance coverage, several indicators of mental health treatment, and improved self-reported health among young adults with mental illness.
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“Among people who recognize their need for mental health treatment, 64% are resistant to reaching out to another person for assistance and 23% have financial, transportation, or time-related barriers to seeking care [13,14].”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [14]
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Leo, A. J., Schuelke, M. J., Hunt, D. M., Metzler, J. P., Miller, J. P., Areán, P. A., Armbrecht, M. A., & Cheng, A. L. (2022) · JMIR Formative Research · doi:10.2196/34889 · Cited by 70
“Among people who recognize their need for mental health treatment, 64% are resistant to reaching out to another person for assistance and 23% have financial, transportation, or time-related barriers to seeking care [13,14].”
BackgroundFry, C., & Sommers, B. D. (2018) · Psychiatric Services · doi:10.1176/appi.ps.201800181 · Cited by 61
“Other research has examined changes in health care access and utilization for persons with mental illness after private coverage expansion, which may differ in its effects from Medicaid (13).”
BackgroundSelf-citationFrerichs, L., Bell, R. A., Lich, K. H., Reuland, D. S., & Warne, D. K. (2019) · Ethnicity and Health · doi:10.1080/13557858.2019.1625873 · Cited by 16
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Shields, M. C., Beaulieu, N. D., Lu, S., Busch, A. B., Cutler, D., & Chien, A. T. (2021) · Psychiatric Services · doi:10.1176/appi.ps.202100182 · Cited by 15
Robertson‐Preidler, J., Trachsel, M., Johnson, T. J., & Biller‐Andorno, N. (2020) · Health Care Analysis · doi:10.1007/s10728-020-00391-0 · Cited by 13
Metadata
- Authors
- Kozloff, N., & Sommers, B. D.
- Affiliations
- St. Michael's Hospital (CA)
- Brigham and Women's Hospital (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2017-08-23
- Volume
- 78
- Issue
- 7
- Pages
- e821-e827
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2734749632
- Cited by
- 25
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 3
- FWCI
- 5.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Employment and Welfare Studies
- Keywords
- Affordable Care Act, young adults, mental illness, health insurance coverage, uninsurance, outpatient psychiatric care, self-reported health, unmet mental health needs, cost barriers, health policy
- MeSH terms
- Adolescent, Adult, Mental Disorders, Child, Female, Humans, Male, United States, Treatment Outcome, Insurance Coverage, Young Adult, Patient Protection and Affordable Care Act
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- CoChat. (2026). Citation check: Insurance Coverage and Health Outcomes in Young Adults With Mental Illness Following the Affordable Care Act Dependent Coverage Expansion. https://app.cochat.ai/papers/10.4088/jcp.16m11357
- The paper
- Kozloff, N., & Sommers, B. D. (2017). Insurance Coverage and Health Outcomes in Young Adults With Mental Illness Following the Affordable Care Act Dependent Coverage Expansion. The Journal of Clinical Psychiatry. https://doi.org/10.4088/jcp.16m11357
