摘要：Objectives. We estimated the effect of the ACA expansion of dependents’ coverage on health care expenditures and utilization for young adults by race/ethnicity. Methods. We used difference-in-difference models to estimate the impact of the ACA expansion on health care expenditures, out-of-pocket payments (OOP) as a share of total health care expenditure, and utilization among young adults aged 19 to 26 years by race/ethnicity (White, African American, Latino, and other racial/ethnic groups), with adults aged 27 to 30 years as the control group. Results. In 2011 and 2012, White and African American young adults aged 19 to 26 years had significantly lower total health care spending compared with the 27 to 30 years cohort. OOP, as a share of health care expenditure, remained the same after the ACA expansion for all race/ethnicity groups. Changes in utilization following the ACA expansion among all racial/ethnic groups for those aged 19 to 26 years were not significant. Conclusions. Our study showed that the impact of the ACA expansion on health care expenditures differed by race/ethnicity. In 2009, approximately 30% of the population aged 19 to 30 years, labeled the “young invincibles,” were uninsured. 1 This group represented 1 in 5 uninsured individuals in the United States. 2 In September 2010, the Affordable Care Act (ACA) extended eligibility for dependents’ coverage under family private health insurance up to age 26 years. 3 Under the ACA expansion of dependents’ coverage, enrollment of employer-sponsored health insurance plans for young adult dependents significantly increased. 3–8 Research showed that this ACA provision reduced the number of uninsured young adults by at least 3 million individuals. 3 Recent studies that used nationally representative data also showed that this ACA expansion significantly reduced young adults’ out-of-pocket payments (OOP). 9,10 Young adults’ health spending patterns with the rollout of the ACA may affect the nation’s aggregate health spending growth rate in the long term. Lack of health insurance may result in limited access to health care, and delaying or forgoing necessary treatment, potentially leading to health problems and greater health expenditures in mid-adulthood. 11,12 Understanding the influence of the expansion specifically on young racial/ethnic minorities is critical, because inadequate access to health care is a major driver of racial/ethnic disparities in health. More than 50% of Latino and one third of African American young adults aged 20 to 29 years were uninsured in 2008 and 2009, compared with 25% of non-Latino White (White) young adults. 13 Lack of health insurance coverage across racial/ethnic groups has been associated with uncertainty over family health expenditures, potentially ruinous OOP, and lower health care access and use. 14–17 Because racial/ethnic minorities had low rates of health insurance coverage before the ACA implementation, it is likely that racial/ethnic minorities would benefit from the ACA expansion on dependents’ coverage. By contrast, this ACA expansion of dependents’ coverage only focused on those whose parents had employer-sponsored health insurance. Compared with Whites, African Americans and Latinos were less likely to have employer-provided private coverage because of income and immigration status, and thus might be less likely to benefit from this expansion. Because of the differences in health insurance coverage, employment status, demographic characteristics, socioeconomic status, and clinical needs, health care expenditures and use patterns might differ by race/ethnicity under the ACA expansion of dependents’ coverage. It is critical to understand these differentiated responses to predict the racial/ethnic disparities in health care under overall ACA health care reform, and to design policies to improve efficiency and equity of the health care system. To our knowledge, this is the first study that examined the effect of the ACA expansion of dependents’ coverage on health care spending and use by race/ethnicity.
