State-Level Estimates of Gains in Insurance Coverage Among Young Adults

Background on ASPE Issue Brief

New results from the National Health Interview Survey (NHIS) indicate that 3.1 million additional young adults have insurance coverage as of December 2011, due to the provision in the Affordable Care Act that allows 19 through 25 year olds to remain on their parents’ insurance plans.

Methods

The NHIS survey is not large enough to allow estimates of how many young adults gained coverage within each State.  So to estimate these numbers, analysts from the Department of Health and Human Services used the most recent state-level, Census Bureau data from before the Affordable Care Act provision went into effect.  They calculated the number of 19 through 25 year olds who did not have health insurance in each state as of 2009 using the Census Bureau’s largest source of state-level data, the American Community Survey.  They then divided up the estimated 3.1 million young adults who have gained insurance proportionately across all 50 states and the District of Columbia, based on their baseline number of uninsured adults in this age group. 

This approach is only a rough approximation.  It assumes that the effect of the Affordable Care Act’s provision for young adults was similar across all states.  This may not be true for several reasons, including differences in population demographics, parental availability of health insurance, and pre-existing laws in some states that already enabled a portion of young adults to enroll in their parents’ plans.  

However, it is notable that the pre-existing State laws in this realm did not apply to private self-insured plans, which are covered under the Affordable Care Act’s dependent coverage provision.  The majority of U.S. workers with insurance (60%) are in self-insured plans not subject to these state laws.[1]   

Additionally, many states had age limits, requirements for student status, or exclusions for married young adults that further limited the impact of these laws. Due to these issues, the vast majority of young adults in the U.S. were not eligible for coverage under pre-existing state laws, which minimized their impact.  This conclusion is supported by research published in peer review journals.  One study showed that pre-existing state laws produced only a small gain in coverage of roughly three percent,[2] while two others showed no overall gain in coverage.[3],[4] There is no evidence that any state experienced anything close to the 10 percentage-point gain in coverage due to the Affordable Care Act’s dependent coverage provision.   

Results

Table 1: Estimated Number of Young Adults (19-25) by State Gaining Health Insurance Due to the Affordable Care Act, through December 2011

 

StateTotal Young Adults Gaining Health Insurance
Alabama49,000
Alaska9,000
Arizona69,000
Arkansas35,000
California435,000
Colorado50,000
Connecticut23,000
District of Columbia3,000
Delaware6,000
Florida224,000
Georgia123,000
Hawaii6,000
Idaho17,000
Illinois125,000
Indiana62,000
Iowa20,000
Kansas25,000
Kentucky48,000
Louisiana53,000
Maine9,000
Maryland46,000
Massachusetts21,000
Michigan94,000
Minnesota35,000
Mississippi37,000
Missouri55,000
Montana12,000
North Carolina95,000
North Dakota5,000
New Hampshire10,000
New Jersey73,000
New Mexico26,000
New York160,000
Nebraska18,000
Nevada33,000
Ohio97,000
Oklahoma49,000
Oregon43,000
Pennsylvania91,000
Rhode Island9,000
South Carolina50,000
South Dakota9,000
Tennessee59,000
Texas357,000
Utah26,000
Vermont5,000
Virginia66,000
West Virginia18,000
Washington62,000
Wisconsin43,000
Wyoming6,000
TOTAL3,101,000

 

  Posted on: June 19, 2012


[1] Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2011
[2] Levine PB, McKnight R, Heep S. How Effective are Public Policies to Increase Health Insurance Coverage Among Young Adults? American Economic Journal: Economic Policy 2011;3:129-56.
[3] Blum AB, Kleinman LC, Starfield B, Ross JS. Impact of state laws that extend eligibility for parents' health insurance coverage to young adults. Pediatrics 2012;129:426-32.
[4] Monheit AC, Cantor JC, DeLia D, Belloff D. How have state policies to expand dependent coverage affected the health insurance status of young adults? Health Serv Res 2011;46:251-67.