The ACA Dependent Coverage Expansion of 2010 and Rates of Suicide Among Young Adults

The expansion of health insurance coverage to those under the age of 26 in late 2010 as a result of the ACA’s dependent coverage provision allowed young adults to remain on their parent’s insurance plan. The effect of this policy change on access to health care services, including mental health care, via reductions in uninsured young adults has been studied in prior research. Based on data from the American Community Survey, rates of uninsurance declined by 4.6 percent for 18-24 year olds between 2010 and 2013 while increasing by 0.2 percent for 25-34 year olds. This study seeks to estimate whether this coverage expansion had a causal effect on suicidal behavior on those dependents eligible to remain on their parent’s insurance plan relative to similar young adults aged just above the cutoff for eligibility.

Data from CDC’s WONDER database show that national suicide rates diverged in 2011 for 22 – 25 year olds relative to 26 – 29 year olds after tracking each other closely for the period from 1999 to 2010 (when the correlation between the two rates was 0.84). From 2010 to 2013, suicide rates for 26 – 29 year olds increased by 7.7% while suicide rates for 22 – 25 year olds declined by 1.4%. Following the expansion of health insurance via Medicaid and the ACA exchanges in 2014, rates of suicide for both groups again converge to similar levels. This project estimates how differential rates of take-up across states of the available insurance coverage from dependents’ parents relates to changes in rates of suicide across age groups and states. In two-thirds of states, increases in rates of suicide were greater for 26 to 29 year olds from 2011 to 2014 relative to 2006 to 2009 than they were for 22 to 25 year olds (who potentially gained access to their parent’s insurance towards the end of 2010). These states represent 79 percent of the young adult population in the U.S. for these age groups indicating that a large majority of young adults lived in states where suicide rates grew faster for age ranges just above the cutoff for eligibility of this dependent coverage.