The Dependent Care Provision Did Not Improve Insurance Rates for Spina Bifida Patients as They Transition to Adult Care

Summary INTRODUCTION Under the Affordable Care Act, the Dependent Care Provision (DCP) was enacted in 2010 and expanded healthcare coverage for millions of young adults ages 19–25 by allowing them to stay on their parents’ insurance until age 26. It is unknown whether the DCP has impacted young adults with SB who are at risk for lapses in insurance coverage as they transition into adult care. Objective Our aim was to determine the impact of the DCP on access to care (insurance status) and healthcare-quality (hospital admissions for potentially preventable conditions). Methods Using the National Inpatient Sample (an all-payor national dataset of hospital admissions), we analyzed pre/post DCP changes for admissions of SB patients ages 19–25. Our outcomes of interest were rates of insurance coverage and proportion of admissions due to potentially preventable conditions (UTI, pyelonephritis, skin conditions, osteomyelitis, sepsis, and pneumonia). Analysis included a difference-in-differences logistic regression model which compared the pre/post DCP difference (2006-s quarter of 2010 vs. 2011–2013) in patients ages 19–25 to the difference in patients ages 26–32 who were ineligible for the DCP policy. Results For admissions of SB patients ages 19–25, the DCP was not associated with improved insurance status compared to admissions ages 26–32 (0% vs. −0.4%, p = 0.10) and rates of private insurance decreased in both age groups, but more so in ages 26–32 (−2.0% vs. −3.9%, p  Discussion Under the Affordable Care Act, the DCP failed to improve rates of private insurance or decrease rates of noninsurance for admissions of young adults with SB. Certain race and socioeconomic groups benefited more from this national healthcare policy. Meanwhile, admissions for potentially preventable conditions are common in spina bifida patients, and increased over the study period, suggesting a need for further investigation into optimizing the delivery of healthcare to this complex patient population. Conclusion The DCP did not result in improved overall insurance rates or in improved rates of private insurance for admissions of SB patients 18–25 years old. Download : Download high-res image (79KB) Download : Download full-size image Summary Figure . Absolute difference in insurance status after implementation of the Dependent Care Provision in 2010. Comparision of insurance rates during the pre-policy era 2006-Q2 2010 with the post-policy era 2011–2013 for ages 19–25 vs. ages 26–32. ∗ indicates a statistically significant difference for the difference-in-differences model comparing the pre/post change for admissions ages 19–25 vs. ages 26–32.