Insurance Coverage and Health Outcomes in Young Adults With Mental Illness Following the Affordable Care Act Dependent Coverage Expansion
Bibliographic record
Abstract
OBJECTIVE: As a provision of the Affordable Care Act, young adults were able to remain on their parents' health insurance plans until age 26. We examined the impact of the 2010 dependent coverage expansion on insurance coverage and health outcomes among young adults with mental illness. METHODS: Data are from the 2008-2013 National Survey on Drug Use and Health, an annual population-based survey of noninstitutionalized US individuals aged 12 and older. We used a difference-in-differences approach to compare young adults with mental illness subject to the provision (aged 19-25 years, n = 19,051) with an older comparison group (aged 26-34 years, n = 7,958) before (2008-2009) and after (2011-2013) the dependent coverage expansion in their insurance coverage, use of health services, and self-reported health. RESULTS: In adjusted analyses, following the dependent coverage expansion, private insurance coverage increased by 11.7 percentage points (95% CI, 8.4-15.1, P < .001) and uninsurance decreased by 8.9 percentage points (95% CI, -12.1 to -5.7, P < .001) among 19- to 25-year-olds with mental illness, relative to 26- to 34-year-olds. The provision was associated with a modest increase in young adults with mental illness who received outpatient mental health treatment at least monthly on average (+2.0% [95% CI, 0.1% to 4.0%, P = .04]) and a modest decrease in those reporting their overall health as fair or poor (-2.3% [95% CI, -4.6% to -0.0%, P = .05]). Unmet mental health needs due to cost decreased significantly among those with moderate-to-serious mental illness (-12.3% [95% CI, -22.7% to -2.0%, P = .02]), but did not change among those with mild illness. CONCLUSIONS: The 2010 dependent coverage expansion was associated with an increase in insurance coverage, several indicators of mental health treatment, and improved self-reported health among young adults with mental illness.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".