This analysis indicates the potential positive impact of a key provision of the Patient Protection and Affordable Care Act of 2010 (ACA). The study appears in the March issue of the journal Pediatrics, the official journal of the American Academy of Pediatrics.
The ACA requires private insurance companies to support children on their parents' policies through age 26. The Mount Sinai research team analyzed the U.S. Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System survey and compared the period before the state laws were enacted (2002 to 2004) to the period after the state laws went into effect (2008 to 2009). They found that in the 34 states that had such laws, the affected patients had greater rates of health insurance, were more likely to identify a personal physician and receive a physical exam, and were less likely to forgo care due to cost.
"These research findings will inform our understanding of what to expect from the federal health reform provision that allows those up to age 26 to join their parents' policy," said Alex Blum, MD, MPH, lead author of the study and Adjunct Assistant Professor of Health Evidence and Policy at Mount Sinai School of Medicine. "Our results predict that many more young people will have a personal doctor and regular checkups, and no longer have to go without care due to cost. These are critical components to provide health security to young people just when they are starting out on their own."
The authors conclude that their findings may underestimate the impact of the ACA. Unlike state laws, the ACA applies to all individuals up to age 26 and is not subject to limitations on self-insured health insurance plans.
"The Employee Retirement Income Security Act exempts all self-insured health insurance plans from the state laws we studied," said Dr. Blum. "Nearly half of all Americans have self- insured policies. It is possible that we only identified half of the likely impact of the ACA provision."
Additionally, six state laws were more generous than the ACA's provision and extended eligibility beyond 26 years. "Four states that enacted laws prior to the ACA imposed premium caps to limit parental costs," Dr. Blum explained. "The ACA could be amended to reach even more young adults by raising the limits to age 29 and by limiting the premiums, as some states have done."
Other authors on the study include Lawrence C. Kleinman, MD, MPH, Vice-Chair for Research and Education, Associate Professor of Pediatrics, and Health Evidence and Policy, Mount Sinai School of Medicine; Barbara Starfield, MD, MPH, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health of Johns Hopkins (deceased); and Joseph S. Ross, MD, MHS, Department of Medicine and Center for Outcomes Research and Evaluation, Yale University School of Medicine/Yale-New Haven Hospital, who began the research while at Mount Sinai.Funding for this research was provided to Dr. Blum by the Health Services & Resources Administration through a Ruth Kirschstein National Research Service Award Fellowship. Dr. Kleinman received some support from the National Institutes of Health via ConduITS Institute for Translational Sciences, funded by an NIH Clinical and Translational Science Award.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2011, US News and World Report ranked The Mount Sinai Hospital 16th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Of the top 20 hospitals in the United States, Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and US News and World Report and whose hospital is on the US News and World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.
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