title: Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients.
abstract: Insurance coverage has increased among young adults as a result of the Affordable Care Act (ACA) provision that allows young adults to remain covered under their parents' plans until age twenty-six. However, little is known about the provision's effects on the clinical outcomes and insurance coverage of patients with trauma--the most frequent cause of death and physical disability among young adults. Using 2007-12 data from the National Trauma Data Bank, we conducted a difference-in-differences analysis of coverage rates among trauma patients ages 19-25 (compared to patients ages 26-34, who served as the control group), and we examined trauma-relevant outcomes by patient, injury, and hospital characteristics. We found a 3.4-percentage-point decrease in uninsurance status among younger trauma patients following the policy change. The decrease was concentrated among men, non-Hispanic whites, those with relatively less severe injuries, and those who presented to nonteaching hospitals. We did not detect significant changes in the use of intensive care or in overall mortality. The heterogeneous coverage impact of the ACA dependent coverage provision on high- versus low-risk trauma patients has implications for future efforts to expand coverage.
authors.affiliation: John W. Scott (jwscott@partners.org) is a resident in general surgery and a research fellow in the Center for Surgery and Public Health, both at Brigham and Women's Hospital, in Boston, Massachusetts.
authors.forename: John W
authors.initials: JW
authors.lastname: Scott
authors.affiliation: Benjamin D. Sommers is an assistant professor of health policy and economics at the Harvard School of Public Health and an assistant professor of medicine at Brigham and Women's Hospital, both in Boston.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.affiliation: Thomas C. Tsai is a resident in general surgery at Brigham and Women's Hospital and a research associate in the Department of Health Policy and Management, Harvard School of Public Health.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Tsai
authors.affiliation: Kirstin W. Scott is a PhD candidate in the Interfaculty Initiative in Health Policy, Harvard University, in Cambridge, Massachusetts.
authors.forename: Kirstin W
authors.initials: KW
authors.lastname: Scott
authors.affiliation: Aaron L. Schwartz is an MD-PhD candidate in the Department of Health Care Policy, Harvard University.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Schwartz
authors.affiliation: Zirui Song is a resident in internal medicine at the Massachusetts General Hospital and a clinical fellow at Harvard Medical School, both in Boston.
authors.forename: Zirui
authors.initials: Z
authors.lastname: Song
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000639:trends*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000639:trends*; D064876:Safety-net Providers / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D015996:Survival Rate; D014481:United States; D014947:Wounds and Injuries / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult
keywords: Access To Care; Disparities; Health Reform; Insurance Coverage < Insurance; Safety-Net Systems