Effects of the affordable care act on private insurance coverage and treatment of behavioral health conditions in young adults

Objectives. To assess changes in private insurance coverage and behavioral treatment of people aged 19 to 25 years and 26 to 35 years following the 2010 Affordable Care Act (ACA) dependent care provision and 2014 insurance reforms. Methods. We extracted data from the 2008 to 2016 US National Surveys on Drug Use and Health. We used an adjusted difference-in-differences approach to assess effects of age group on change in coverage. Replications in subgroups with serious psychological distress or substance use disorders also assessed change in mental health and substance use treatment. Results. Between 2008 to 2010 and 2011 to 2013, the increase in coverage of the younger group significantly differed from the decrease in the older group, but the 2 groups did not significantly differ between 2011 to 2013 and 2014 to 2016 (+3.2 percentage points; P < .001; and +3.8 percentage points; P < .001). Similar trends occurred among the distressed subgroups and the younger but not older substance use subgroup who reported no significant coverage changes in either period. A minority in the distressed (31.4%-45.4%) and substance use (5.1%-8.5%) subgroups received treatment. Conclusions. Although implementation of the ACA provisions coincided with coverage gains for young adults, challenges persist in engaging those with mental health and substance use problems in treatment.