Young Adult Preventive Healthcare: Changes in Receipt of Care Pre- to Post-Affordable Care Act

Abstract

A B S T R A C TPurpose: Young adults have unique health and health care needs. Although morbidity and mortality stem largely from preventable factors, they lack a structured set of preventive care guidelines. The Affordable Care Act (ACA), enacted in 2010, increased young adult insurance coverage, prohibited copayments for preventive visits among privately insured and for many preventive services. The objectives were to evaluate pre-to post-ACA changes in young adults' past-year well visits and, among those using a past-year health care visit, the receipt of preventive services. Methods: We used pooled Medical Expenditure Panel Survey data, comparing pre-ACA (2007e2009, N ¼ 10,294) to post-ACA (2014e2016, N ¼ 10,567) young adults aged 18e25 years. Bivariable and multivariable stratified logistic regression, adjusting for sociodemographic covariates, were conducted to determine differences in well visits and in preventive services among past-year health care utilizers: blood pressure and cholesterol checks, influenza immunization, and all three received. Results: Past-year well visits increased from pre-ACA (28%) to post-ACA (32%), p < .001. Increases were noted for most demographic subgroups with greatest increases among males, Asian, and highest income subgroups. Larger pre-to post-ACA increases were found for most of the preventive services, p < .05, including the receipt of all three services (7% vs. 16%), p < .001, among past-year health care utilizers. Conclusion: Following ACA implementation, young adults experienced modest increases in well visit rates and larger increases in most preventive services received. Overall rates of both remain low. Building on these improvements requires concerted efforts that account for young adults' unique combination of health care issues and challenges in navigating an adult health care system.

Epidemiology and Trends of Hereditary Hemorrhagic Telangiectasia in the United States

“…The most common HHT-related complication was epistaxis which was consistent with the literature. 2,24,30 The results of our bivariate analyses indicate that HHT patients presenting with epistaxis were at an increased risk for various hemorrhagic and thrombotic complications compared to HHT patients without epistaxis. Based on our findings, we recommend that any patient with suspected HHT presenting with epistaxis be managed in a multidisciplinary fashion as the odds of these patients sustaining life-threatening complications are too high to ignore.…”

“…13,28,29 In addition, the high percent increase in prevalence observed in this demographic may be due to the annual increase in the number of young adults with insurance coverage since the implementation of the Affordable Care Act. 30 The minimal percent increase in the prevalence of HHT in pediatric patients suggests that genetic testing is underutilized in the United States. Because the mean age of epistaxis onset is approximately 12 years of age, diagnostic tools that heavily rely on clinical symptoms, such as the Curac¸ao criteria, have been demonstrated to be less effective at diagnosing children and adolescents with HHT than adults.…”

“…13,28,29 In addition, the high percent increase in prevalence observed in this demographic may be due to the annual increase in the number of young adults with insurance coverage since the implementation of the Affordable Care Act. 30…”

Health and Dental Insurance and Health Care Utilization Among Children, Adolescents, and Young Adults With CKD: Findings From the CKiD Cohort Study

“…We hypothesize that the ACA is responsible for these changes because of provisions requiring insurers to allow children to be on parental plans until age 26. 27 , 28 Multiple studies have demonstrated that the ACA substantially increased access to and utilization of health care among young adults, 30 , 31 , 32 including those with special health care needs. 33 For example, Salciccioli et al 34 demonstrated that among US hospitalizations, the proportion of uninsured patients among young adults with congenital heart disease decreased steadily from 2007-2010 (10.9%), to 2007-2013 (9.3%), to 2014-2016 (6.4%).…”

Improving Adult Vaccination Status in the United States

“…A key predictor of influenza vaccination in the Hispanic community is healthcare coverage, which illustrates the importance of ensuring financial access to health care [6]. Vaccinations, including annual influenza vaccines, often require out-of-pocket expenses even when people have health insurance coverage in the form of co-payments or the full cost of service in pharmacies, even with improvements in coverage of preventive services under the Affordable Care Act [7] and the Medicare program.…”