The effect of the affordable care act dependent coverage provision on patients with cystic fibrosis.
The Patient Protection and Affordable Care Act (ACA), enacted in 2010, expanded private insurance coverage of young adults through the dependent coverage provision. This policy's implications for patients with cystic fibrosis (CF) are unknown.



The CF Foundation Patient Registry was used to identify patients seen at CF centers, 3 years before and after ACA implementation. Patients were grouped according to eligibility for the dependent care provision (18-25 years old in 2010) or ineligibility (26-35 years old). Year-level difference-in-difference logistic regressions evaluated the association between ACA enactment and insurance status (private, public, or no insurance). Routine annual care consistent with CF Foundation guidelines (≥4 clinic visits, ≥4 respiratory cultures, and ≥2 pulmonary function tests/year) was a secondary outcome.



The analysis included 4,024 and 3,132 patients in the eligible and ineligible groups, respectively (35,353 patient-years). In the eligible group, 62% had private insurance before and after ACA; 18% had public insurance before and after ACA; and 5% switched from public to private insurance. In the eligible group, lack of insurance coverage became more common in the post-ACA period (relative risk ratio vs. private insurance [RRR] = 1.95; 95%CI: 1.57, 2.43; P < 0.001). Public insurance coverage also became more common (RRR = 1.50; 95%CI: 1.39, 1.62; P < 0.001). Use of routine care increased post-ACA, but more strongly in the ineligible group than in the eligible group.



The ACA dependent coverage provision did not increase private insurance coverage or use of routine care among CF patients who were potentially affected by this policy. Pediatr Pulmonol. 2017;52:458-466. © 2017 Wiley Periodicals, Inc.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Dmitry
D
Tumin
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
Susan S
SS
Li
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Benjamin T
BT
Kopp
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Stephen E
SE
Kirkby
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.|Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio.
Joseph D
JD
Tobias
Department of Pediatrics, University of Arizona, Tucson, Arizona.
Wayne J
WJ
Morgan
Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.|Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
Don
D
Hayes
D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D003550:Cystic Fibrosis / Q000191:economics*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D058991:Patient Protection and Affordable Care Act; D014481:United States; D055815:Young Adult
Patient Protection and Affordable Care Act; access to health care; cystic fibrosis; insurance