title: The ACA's Dependent Coverage Expansion and Out-of-Pocket Spending by Young Adults With Behavioral Health Conditions.
abstract: Young adults with behavioral health conditions (mental or substance use disorders) often lack access to care. In 2010, the Affordable Care Act (ACA) extended eligibility for dependent coverage under private health insurance, allowing young adults to continue on family plans until age 26. The objective of this study was to analyze out-of-pocket (OOP) spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. The study examined the population of young adults with behavioral health conditions overall and by race and ethnicity.
  
  
  
  The study analyzed 2008-2009 and 2011-2012 nationally representative data from the Medical Expenditure Panel Survey with zero-or-one inflated beta regression models in a difference-in-differences framework to estimate the impact of the ACA's dependent coverage expansion. OOP spending was examined as a share of total health care expenditures among young adults with behavioral health disorders. The study compared the treatment group of individuals ages 19-25 (unweighted N=1,158) with a group ages 27-29 (unweighted N=668).
  
  
  
  Young adults ages 19-25 with behavioral health disorders were significantly less likely than the older group to have high levels of OOP spending after the implementation of the ACA's dependent coverage expansion. The reduction was pronounced among young adults from racial-ethnic minority groups.
  
  
  
  The extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.
authors.affiliation: Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: mir.ali@samhsa.hhs.gov ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables.
authors.forename: Mir M
authors.initials: MM
authors.lastname: Ali
authors.affiliation: Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: mir.ali@samhsa.hhs.gov ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: mir.ali@samhsa.hhs.gov ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables.
authors.forename: Ryan
authors.initials: R
authors.lastname: Mutter
authors.affiliation: Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: mir.ali@samhsa.hhs.gov ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Novak
authors.affiliation: Dr. Ali and Dr. Mutter are with the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: mir.ali@samhsa.hhs.gov ). Dr. Chen and Ms. Novak are with the Department of Health Services Administration, School of Public Health, University of Maryland at College Park, College Park, Maryland. Ms. Novak is also an employee of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mortensen is with the Department of Health Sector Management and Policy, School of Business Administration, University of Miami, Coral Gables.
authors.forename: Karoline
authors.initials: K
authors.lastname: Mortensen
mesh_terms: D000328:Adult; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000628:therapy; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult