Changes in Insurance Coverage and Access to Care for Young Adults in 2017

Purpose: Previous work has demonstrated the Affordable Care Act (ACA) increased young adults’ healthcare access during its first years. However, it is unclear if these trends continued through 2017; recent policies enacted by the Trump administration may have decreased the ACA’s effectiveness. Our purpose was to determine changes in young adults’ health care access during the transition from the Obama to Trump administrations.

Methods: Data on non-institutionalized U.S. young adults 18-24 years) was obtained from the Behavioral Risk Factor Surveillance System 2011-17 (N=173,848). We employed interrupted time series & difference-in-differences analysis to quantify changes in self-reported insurance coverage, access to a primary care physician, and unmet care due to cost from 2013-2017.

Results: Young adults’ healthcare access continued to improve through 2016; for instance, the percentage of respondents experiencing uninsurance declined by 8.7 points from 2013-2016 (95% CI -9.4 to -8.0). However, these trends began to reverse and from 2016 to 2017, the percentage of young adults who experienced uninsurance increased by 1.4 points (95% CI 0.6 to 2.1), not having a personal doctor increased by 1.1 points (95% CI 0.2 to 2.0), and unmet care due to cost increased by 1.0 points (95% CI 0.3 to 1.7). The 2017 declines in access were concentrated in states which did not expand Medicaid and in households earning above 138% of federal poverty level.

Conclusions: Healthcare access declined for young adults in 2017, following several years of improvements. These changes correspond with recent policy actions which may have weakened the ACA’s reforms.