ACA Causes Modest Change in ED Use Among Young Adults

Young adults appear to have changed their use of the emergency department (ED) since the implementation of the Affordable Care Act to reflect a more efficient use of medical care, according to a new report in the Annals of Emergency Medicine.

The ACA’s provision that allows young adults to stay on their parents’ health plans until age 26 has resulted in a decreased annual rate of ED visits by individuals between the ages of 19 and 25 years. ED use was down 1.4% in 2011, which represented 191,000 fewer ED visits among this age group.

“To put this in context, prior to implementation of the Affordable Care Act, young adults had the highest uninsured rate of any age group,” Richard Kronick, PhD, director of the Agency for Healthcare Research and Quality, who was not involved in the study, wrote in a blog post for HHS. “While they are generally healthier than the overall population, they are also at elevated risk for a variety of health and safety issues, including sports injuries, motor vehicle accidents, and mental health challenges.”

The researchers used a database of more than 17 million ED visits from 2007 to 2011 and compared young adults aged 19-25 years to adults aged 27-29 years both before and after the implementation of the ACA.

They found that the decrease in ED visits was mostly concentrated among women, weekday visits, nonurgent conditions, and conditions that can be treated in other settings. There was no effect among weekend visits, visits due to injuries, or urgent conditions. The ACA has also changed the insurance composition of ED visits, with the proportion of privately insured young adults increasing and the fraction of those insured through Medicaid and those who were uninsured decreased.

“The results of our study suggest that even when the Patient Protection and Affordable Care Act is fully implemented, population-level changes in ED use may likely be modest, though future research will be needed to assess the effect of coverage expansions on the broader range of adults—in terms of both income and age—who will gain coverage under the act during the coming decade,” the authors concluded.