The Association between Insurance Access and Vaccination Status among Adult Children under Age 26

Previous studies suggest that increased health insurance coverage is associated with improved vaccination coverage. The 2010 Patient Protection and Affordable Care Act (ACA) mandates health plans to cover dependents up to age 26, regardless of their marital status, student status, residency with parents, or financial dependency. Meanwhile, new health insurance plans provide coverage for ACIP-recommended vaccines without deductibles or co-pays, when delivered by an in-network provider.  Several studies examine the impact of the ACA extension on inpatient and outpatient visits among young adults, while little is known about the impact of this mandate on preventive care utilization including vaccination uptake among young adults. In this paper, we study the association between increased private insurance coverage and influenza vaccination status among adult children. We combine both state level and federal level policy data from previous studies with data on vaccination status from the Behavioral Risk Factor Surveillance System (BRFSS).  We employ a difference-in-difference (DID) approach to estimate the association between private insurance coverage and health care access including access to immunization services. We also use year fixed effects to control for secular trends in vaccination rates at the national level, and state-specific fixed effects to control for time-invariant state-level differences in vaccine uptake rates.  Compared with adults aged 27-30 (the control group), we perform the analysis separately for influenza vaccination among female and male young adults aged 19 to 25.  Data on state and federal policy toward insurance coverage extension to dependents came from the National Conference of State Legislatures. Data on vaccine coverage rates came from the 2008-2012 BRFSS.  Our study aims to provide additional evidence that health insurance coverage may be an important determinant of access to and use of preventive health services among young adults.