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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.


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.


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

State Total Young Adults Gaining
Health Insurance
Alabama 49,000
Alaska 9,000
Arizona 69,000
Arkansas 35,000
California 435,000
Colorado 50,000
Connecticut 23,000
District of Columbia 3,000
Delaware 6,000
Florida 224,000
Georgia 123,000
Hawaii 6,000
Idaho 17,000
Illinois 125,000
Indiana 62,000
Iowa 20,000
Kansas 25,000
Kentucky 48,000
Louisiana 53,000
Maine 9,000
Maryland 46,000
Massachusetts 21,000
Michigan 94,000
Minnesota 35,000
Mississippi 37,000
Missouri 55,000
Montana 12,000
North Carolina 95,000
North Dakota 5,000
New Hampshire 10,000
New Jersey 73,000
New Mexico 26,000
New York 160,000
Nebraska 18,000
Nevada 33,000
Ohio 97,000
Oklahoma 49,000
Oregon 43,000
Pennsylvania 91,000
Rhode Island 9,000
South Carolina 50,000
South Dakota 9,000
Tennessee 59,000
Texas 357,000
Utah 26,000
Vermont 5,000
Virginia 66,000
West Virginia 18,000
Washington 62,000
Wisconsin 43,000
Wyoming 6,000
TOTAL 3,101,000

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.


Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on June 19, 2012
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