Pre- and Post Affordable Care Act Participation in Insurance and Uptake of Sexual Health Services By Self- or Parentally-Insured Females

Background: Little is known about the association between an Affordable Care Act of 2010 (ACA) provision allowing young adults to remain on parents’ insurance up to age 26 and uptake of insurance by insured dependents (i.e., someone other than the primary policyholder). Previous literature indicates that a lack of confidentiality may reduce receipt of sexual health services (SHS) by insured dependents; the interplay between coverage expansions and receipt of SHS requires further investigation.

Methods: We analyzed Truven MarketScan data for 2007-2014, including claims information for commercially-insured females enrolled in participating health plans, to examine: 1) participation in a health plan by females aged 18-25, controlling for age, insurance status, and year; and, 2) associations between relationship to policyholder (self, parent) and receipt of SHS (any reproductive health service, chlamydia screening), controlling for age and year.

Results: There was a marked increase in the proportion of females insured through their parents beginning in 2010 (β=2.4106, OR=11.14, p<0.0001). Across years, the proportion of parent-dependent insureds remained fairly stable for females aged 18-20 years, while a continuous uptick in parent-dependent insureds was seen for those ages 21-25. Overall, however, the proportion of young women receiving a reproductive health service (OR=0.640, p<0.0001) and chlamydia screening (OR=0.969, P=0.0012) were lower among parent-dependent as opposed to self-insureds. 

Conclusions: Although pre-ACA data show health plan participation differing drastically by age, these disparities diminished post-ACA. Beginning in 2010, the proportion of females aged 18-25 years who were under their parents’ insurance began to increase, possibly due to the impact of the ACA provision allowing these individuals to remain on their parent’s insurance. However, as being insured through a parent was also associated with lower use of sexual health services, the benefits of increased coverage may have been partially mitigated by concerns regarding confidentiality.