title: Improvement in preventive care of young adults after the affordable care act: the affordable care act is helping.
abstract: OBJECTIVE
  The 2010 Affordable Care Act (ACA) included expansion of insurance coverage for young adults and improved access to preventive care.
  
  
  OBJECTIVE
  To examine the ACA's initial effects on young adults' receipt of preventive care.
  
  
  METHODS
  Secondary data analysis using a pre-post design that compared health care use by young adults (aged 18 to 25 years) from 2009 and 2011 Medical Expenditure Panel Surveys. Data were collected through computer-assisted personal interviews of a nationally representative sample of the noninstitutionalized US population.
  
  
  METHODS
  Differences by year in rates of receiving a routine examination in the past year, blood pressure screening, cholesterol screening, influenza vaccination, and annual dental visit. Three logistic regression models were developed to (1) compare pre-ACA (2009) and post-ACA (2011) rates of receiving preventive care and (2) determine if post-ACA increases in insurance coverage accounted for changes in preventive care rates. Model 1 was a bivariate model to determine differences in preventive care rates by year; model 2, a multivariable model adding insurance status (full-year private, full-year public, partial-year uninsured, and full-year uninsured) to determine whether insurance accounted for survey year differences; and model 3, a multivariable model adding covariates (usual source of care and sociodemographic variables) to determine whether they further accounted for differences by survey year or insurance status.
  
  
  RESULTS
  After ACA, young adults had significantly higher rates of receiving a routine examination (47.8% vs. 44.1%; P < .05), blood pressure screening (68.3% vs. 65.2%; P < .05), cholesterol screening (29.1% vs. 24.3%; P < .001), and annual dental visit (60.9% vs. 55.2%; P < .001) but not an influenza vaccination (22.1% vs. 21.5%; P = .70). Full-year private insurance coverage increased (50.1% vs. 43.4%; P < .001), and rates of lacking insurance decreased (partial-year uninsured, 18.4% vs. 20.7%; P = .03; and full-year uninsured, 22.2% vs. 27.1%; P < .001). Full-year public insurance rates remained stable (9.4% vs. 8.8%; P = .53). Insurance status fully accounted for the pre- and post-ACA differences in routine examination and blood pressure screening and partially accounted for year differences for cholesterol screening and annual dental visits. Covariate adjustment did not affect year differences.
  
  
  CONCLUSIONS
  The ACA provisions appear to increase insurance coverage and receipt of preventive services among young adults. Further studies are needed to replicate these findings as other ACA provisions are implemented.
authors.affiliation: Division of Adolescent and Young Adult Medicine, University of California, San Francisco.
authors.forename: Josephine S
authors.initials: JS
authors.lastname: Lau
authors.affiliation: Division of Adolescent and Young Adult Medicine, University of California, San Francisco.
authors.forename: Sally H
authors.initials: SH
authors.lastname: Adams
authors.affiliation: Division of Adolescent and Young Adult Medicine, University of California, San Francisco.
authors.forename: M Jane
authors.initials: MJ
authors.lastname: Park
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco.
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.affiliation: Division of Adolescent and Young Adult Medicine, University of California, San Francisco.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Irwin
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D058991:Patient Protection and Affordable Care Act; D010808:Physical Examination / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult