183 The Affordable Care Act: Disparities in Emergency Department Use for Mental Health Diagnoses in Young Adults

Abstract

Young adults have high levels of mental health needs but often lack health insurance. Recent health reforms have increased coverage, but it is unclear how this has effected psychiatric emergency department (ED) visit rates for each sex and various racial subgroups. In 2010, the Affordable Care Act (ACA) required insurers to permit children to remain on parental policies until age 26 as dependents. This study estimated the association between the dependent coverage provision and changes in young adults’ usage of (ED) services for psychiatric diagnoses. Quasi-Experimental analysis of emergency department use in California from 2009-2011 encompassing 280,798 visits with a behavioral health diagnosis for individuals aged 19 to 31 years old. Analyses used a difference-in-differences approach comparing those targeted by the ACA dependent provision (19- to 25-year-olds) and those who were not (27- to 31-year-olds), evaluating changes in ED visit rates per 1,000 in California. Primary outcome measures included the quarterly ED visit rates with any psychiatric diagnosis, with subgroup analysis looking at the effects of race (white, black, Hispanic, Native American, Asian/Pacific Islander, mixed/other) and sex on the primary outcome. The young adult dependent provision was associated with 0.05 per 1,000 people (P < .001) fewer psychiatric ED visits among 19 to 25-year-olds compared to 27 to 31-year-olds. However, this significant reduction in psychiatric ED visits was not seen in males, Hispanics, Asians or Pacific Islanders. Furthermore, Hispanics, Asians, and Pacific Islanders were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance. The young adult dependent provision was associated with a modest reduction in ED use for psychiatric purposes; however, racial disparities in the effect of this provision appear to exist for Hispanics, Asians, and Pacific Islanders.