title: The Affordable Care Act reduces emergency department use by young adults: evidence from three States.
abstract: The Affordable Care Act (ACA) extended eligibility for health insurance for young adults ages 19-25. This extension may have affected how young adults use emergency department (ED) care and other health services. To test the impact of the ACA on how young adults used ED services, we used 2009-11 state administrative records from California, Florida, and New York to compare changes in ED use in young adults ages 19-25 before and after the ACA provision was implemented with changes in the same period for people ages 26-31 (the control group). Following implementation of the ACA provision, the younger group had a decrease of 2.7 ED visits per 1,000 people compared to the older group--a relative change of -2.1 percent. The largest relative decreases were found in women (-3.0 percent) and blacks (-3.4 percent). 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. When we compared the probability of ever using the ED before and after implementation of the ACA provision, we found a minimal decrease (-0.4 percent) among the younger group compared to the older group. This suggests that the change in the number of visits was driven by fewer visits among ED users, not by changes in the number of people who ever visited the ED.
authors.affiliation: Tina Hernandez-Boussard (boussard@stanford.edu) is an assistant professor of surgery and biomedical informatics (courtesy) at Stanford University, in California.
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.affiliation: Carson S. Burns is a medical student at the Stanford University School of Medicine.
authors.forename: Carson S
authors.initials: CS
authors.lastname: Burns
authors.affiliation: N. Ewen Wang is an associate professor of surgery at Stanford University.
authors.forename: N Ewen
authors.initials: NE
authors.lastname: Wang
authors.affiliation: Laurence C. Baker is a professor of health research and policy at Stanford University.
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Baker
authors.affiliation: Benjamin A. Goldstein is a biostatistician at the Stanford University School of Medicine.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D002140:California; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D009518:New York; D058991:Patient Protection and Affordable Care Act
keywords: Access To Care; Health Reform; Insurance Coverage < Insurance