Are the Times A-Changing? Healthcare Coverage and Access for Adolescents and Young Adults Since the Affordable Care Act

Abstract

Advocates for adolescents and young adults (AYA) worked hard to make sure that the Affordable Care Act (ACA) met the needs of all AYA, especially those who are most vulnerable. Two articles in this month's issue of the Journal of Adolescent Health present analyses on one vulnerable group, AYA with special health care needs (AYA-SHCN) [1,2]. Both articles demonstrate how these young people have benefited from the ACA and where they stand now with respect to access to care. Focusing on AYA-SHCN serves several information needs. As a group, AYA-SHCN are particularly vulnerable to changes in the access to and the organization and delivery of healthcare. This group is often dependent on healthcare in order to reach their optimal health and well-being. They need and use considerable resources. Policy makers and practitioners need up-to-date information in order to develop and manage healthcare resources, including training of providers. Additionally, AYA-SHCN are an important group because they may be an early indicator of how changes in policy and delivery impact AYA more generally [3]. The dependent coverage provision of the ACA made it possible for young adults (YA) to remain enrolled in family insurance coverage until age 26. We know from many studies that this provision contributed substantially to the decline in the proportion of YA who are uninsured [4]. The article by Chan et al. in this issue contributes to our understanding of dependent coverage expansion specifically in the context of YA-SHCN [1]. Their findings illustrate the positive effect of the ACA. The proportion of YA-SHCN who experienced insurance gaps dropped from 48.3% before implementation of the ACA to 45.9% afterward, demonstrating that the dependent care provision is providing a pathway to better access to care for these vulnerable young people. However, beyond the positive effects highlighted by the authors, several aspects of YA-SHCN's access to care remain concerning. Nearly half of all YA-SHCN experienced a gap in insurance coverage over a 4-month interval even after implementation of the ACA. Periods of being uninsured leave YA with a decision between getting the care they need and incurring the substantial cost of care. Other research on the ACA dependent coverage provision demonstrates that the benefits accrue disproportionately to YA with higher incomes [5]. Chan et al. do not specifically determine who among YA-SHCN benefits most [1]. If, however, extrapolating prior

Prevalence of Unmet Healthcare Needs in Adolescents and Associated Factors: Data from the Seventh Korea National Health and Nutrition Examination Survey (2016–2018)

“…Among countries, the prevalence of unmet healthcare needs seems to be associated with health costs, which are related to the coverage by the national insurance system [ 22 , 23 ]. For example, the US has also reported a reduction in the prevalence of unmet healthcare needs by extending the benefits of Medicaid [ 24 , 25 ].…”