Health Status of Young Adults with Insurance Coverage Before and After Affordable Care Act Passage

INTRODUCTION: The purpose of this study was to assess changes in health status of California young adults with insurance coverage before and after passage of the Affordable Care Act (ACA). METHODS: For this cross-sectional descriptive study, electronic health record information for young adults between ages 18 and 25 years enrolled in a large Southern California Health Plan in 2008, 2010, or 2015 was obtained (N = 665,686). Absolute changes and standardized annual differences in demographics and age-sex-race standardized prevalence of Elixhauser health conditions for pre-ACA (2008-2010) and post-ACA (2010-2015) periods were calculated. RESULTS: The number of young adults enrolled in the Health Plan increased by 145,000 (65%) during the ACA transition with a shift toward low-income young adults. The increase in high-deductible insurance plans observed pre-ACA stabilized with a standardized annual difference of 0.22 pre-ACA vs 0.05 post-ACA. The prevalences of obesity and other health conditions between pre-ACA and post-ACA periods essentially were unaltered and comparable between young adults who became new members (< 1 year) and those with long-term memberships (≥ 3 years). CONCLUSION: In this California health care system, the health status of new young adult members was comparable to that of long-term members. Future research should assess whether these young adults retain their health insurance coverage after turning age 26 years and being removed from their parents' insurance plans.