One provision of the Affordable Care Act – the health legislation popularly known as Obamacare – allows young people, aged 19 to 25, to be covered by their parents’ health-insurance plans. The provision is called dependent-care coverage and prior to September 2010, when it came into effect, this age group had one of the highest uninsured rates in the United States. Around 30 percent of these young men and women were uninsured, compared to 16 percent of all Americans, on average.
A new study looks at how this single provision may save hundreds of lives a year.
An academic study worth reading: “The Affordable Care Act’s Dependent-Care Coverage and Mortality,” in Medical Care, 2017.
Study summary: When the ACA dependent-care provision came into effect, coverage rates for this age group rose significantly; 6.6 million individuals gained insurance, according to Census Bureau data.
Chandler McClellan, a health economist at the U.S. government agency that works on substance abuse and mental health, wanted to know if this policy change saved lives — in part, as a way of assessing the value of health insurance coverage for policymakers.
He used government data on causes of death from 2008 to 2013, a period that included the adoption of the ACA, and chose individuals aged 19-30. This allowed McClellan to compare the affected group (those aged 19-25) with a natural control unaffected by the coverage expansion: those aged 26-30.
McClellan focused on disease-related mortality, since these conditions are often treatable, yet he also considered other causes of death “to fully examine the potential effects of the dependent coverage provision.”
His findings suggest that, with insurance, young people are going to the doctor more and getting treatment for conditions before they become fatal.
Key takeaways:
- The dependent-care provision was associated with a 6.1 percent decline in disease-related deaths after the provision went into effect – about 30 fewer deaths per month or 357 per year – among Americans aged 19-25.
- “Most of the lives saved are due to reductions in deaths related to cardiovascular, cancer, and other disease-related causes.”
- The dependent-care provision did not significantly impact deaths from other causes, such as accidents, which remain a more frequent cause of death for this age group. Federal law requires emergency rooms to treat emergencies regardless of one’s insurance. McClellan found no change in death rates from trauma, suggesting “that it is the health insurance expansion that is driving the reduction in disease-related deaths.”
- In both age groups, men, white people and non-Hispanics make up a larger share of deaths.
- “Men experienced the largest reductions in overall disease-related and cancer-related mortality, with 8.1 percent and 12.2 percent reductions, respectively, while cardiovascular deaths [such as heart attacks] among women fell by 11.7 percent.”
- White people, overall, experienced a 14.6 percent decline in cardiovascular mortality.
- McClellan expects “larger declines in mortality later” because medical care has a cumulative effect; “chronic diseases become better managed” when people have health insurance.
- Though the author cautions that he cannot prove causality, he says he cannot identify other factors that explain these results.
Helpful resources:
- The Centers for Disease Control and Prevention (CDC) keeps track of causes of death across the U.S.
- The Census Bureau publishes annual data on health insurance coverage.
- Here is the government’s resource page on the ACA.
- Related papers we have profiled include a 2017 study that found doctors catching more cancers earlier after the introduction of the ACA and a 2016 survey on the priciest ailments in the United States, which also declared that the cost of healthcare is rising faster than inflation.
- A 2014 study in the American Journal of Psychiatry looks at how the ACA impacted mental-health care for young adults.
- A 2014 paper in the Annals of Internal Medicine found a decline in mortality after Massachusetts introduced health care reform in 2006, a law on which the ACA was modeled.
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