title: Impact of ACA Insurance Coverage Expansion on Perforated Appendix Rates Among Young Adults.
abstract: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act allowed young adults to remain on their parents' health insurance plans until age 26 years. Although the provision improved coverage and survey-reported access to care, little is known regarding its impact on timely access for acute conditions. This study aims to assess changes in insurance coverage and perforation rates among young adults with acute appendicitis-an established metric for population-level health care access-after the DCP.
  
  
  
  The National Inpatient Sample and difference-in-differences linear regression were used to assess prepolicy/postpolicy changes for policy-eligible young adults (aged 19-25 y) compared with a slightly older, policy-ineligible comparator group (aged 26-34 y).
  
  
  
  After adjustment for covariates, 19-25 year olds experienced a 3.6-percentage point decline in the uninsured rate after the DCP (baseline 22.5%), compared with 26-34 year olds (P<0.001). This coincided with a 1.4-percentage point relative decline in perforated appendix rate for 19-25 year olds (baseline 17.5%), compared with 26-34 year olds (P=0.023). All subgroups showed significant reductions in uninsured rates; however, statistically significant reductions in perforation rates were limited to racial/ethnic minorities, patients from lower-income communities, and patients presenting to urban teaching hospitals.
  
  
  
  Reductions in uninsured rates among young adults after the DCP were associated with significant reductions in perforated appendix rates relative to a comparator group, suggesting that insurance expansion could lead to fewer delays in seeking and accessing care for acute conditions. Greater relative declines in perforation rates among the most at-risk subpopulations hold important implications for the use of coverage expansion to mitigate existing disparities in access to care.
authors.affiliation: *Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health †Program For Global Surgery And Social Change, Harvard Medical School ‡Department of Health Policy and Management, Harvard T.H. Chan School of Public Health §Massachusetts Eye & Ear Infirmary, Department Of Otolaryngology & Office of Global Surgery ∥Department of Medicine, Brigham & Women's Hospital ¶Department of Surgery, Division of Trauma, Brigham & Women's Hospital, Boston, MA.
authors.forename: John W
authors.initials: JW
authors.lastname: Scott
authors.forename: John A
authors.initials: JA
authors.lastname: Rose
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Tsai
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000328:Adult; D000367:Age Factors; D001064:Appendicitis / Q000191:economics*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D017057:Medically Uninsured / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act; D055815:Young Adult