Impact of healthcare reform on the payer mix among young adult emergency department utilizers across the United States (2005–2015)

Before the patient protection and affordable care act (ACA), young adults (20 to 34) had the highest uninsured rates in the United States (US) and frequently sought care in emergency departments (EDs). We aimed to determine if there was a measurable effect of expanded coverage, specifically the dependent coverage provision and Medicaid expansion, on the payer mix of young adults in EDs. We performed a retrospective cross-sectional study of ED utilization among young adults across the US using the national hospital ambulatory medical care survey (NHAMCS) (2005–2015). We examined the effect of health reform changes on the prevalence and odds of having an insurance type among ED utilizers (19–30) in 3 time periods (2005–2010), (2011–2013), and (2014–2015). Additionally, we compared the national and ED payer mix proportions among 19 to 25 and 26 to 30-year-olds. Our results indicate significant proportional changes in the national and ED payer mix relative to a pre-ACA time period. The 2 greatest changes to the national payer mix were the reduction in the proportion of uninsured/self-payers and the increase in the proportion covered by Medicaid. Furthermore, the dependent coverage provision was effective in increasing the proportion of those (19–25) utilizing private insurance coverage. Lastly, there is now a lower proportion of uninsured young adults in the ED, and an increased proportion of those covered by Medicaid. The change in payer mix among young adults has potential long-term consequences for the provision of emergency department services in the U.S.