The Affordable Care Act and Adolescents

By: Diane Pilkey, Laura Skopec, Emily Gee, Kenneth Finegold, Kerent Amaya, ASPE 
and Wilma Robinson, Office of Adolescent Health

Abstract

This ASPE Issue Brief describes provisions in the Affordable Care Act that impact adolescents such as the prohibition on pre-existing conditions denials and expansion of Medicaid coverage. The brief also includes data on the eligible uninsured adolescent population ages 10-19. The brief was developed collaboratively between ASPE and the Office of Adolescent Health.

Over 42 million adolescents (ages 10 to 19) live in the United States, making up roughly 14 percent of all Americans.¹  About 9.8 percent of youth ages 12-17 lack health insurance.²  The health care needs of adolescents are different from those of adults and children. Although adolescents are generally healthy, access to health care, preventive care, and health education is important to ensure continued health throughout their lives.³  The behavioral patterns established during the second decade of life help influence not only the current health status of adolescents, but their risk for developing chronic diseases into adulthood. For example, adolescents who are obese are more likely to be obese as adults and are therefore more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.⁴  In addition, there are significant disparities in outcomes among racial and ethnic groups for adolescents. In general, adolescents and young adults who are African American, American Indian or Alaska Native, or Latino, especially those who are living in poverty, experience worse outcomes in a variety of areas (obesity, teen pregnancy, tooth decay, and educational achievement) compared to adolescents who are White or who are more economically advantaged.⁴

An estimated 9.8 percent of adolescents ages 12-17 lack health insurance and 4.7 percent have no usual source of health care.² Adolescents are worse off than younger children in both respects.⁵  The Affordable Care Act includes several provisions that are expected to improve health and access to healthcare for adolescents.  An estimated 4.2 million uninsured adolescents ages 10-19 will be eligible to gain health care coverage under the Affordable Care Act beginning January 1, 2014.⁶ While states have new opportunities to expand Medicaid eligibility for adults (including adolescents ages 19 and older) with income up to 133% of the Federal Poverty Level (FPL), all states must cover children up to age 19 with family incomes below 133% of the FPL through the Medicaid program.⁷ About 40 percent of these eligible uninsured (U.S. citizens and legal immigrants) adolescents are non-Latino White, 35 percent are Latino, and 16 percent are non-Latino African American (Table 1). An estimated 2.2 million (53 percent) are male and 1.9 million are female, and 776,000 (19 percent) live in rural areas of the United States (data not shown). The estimated share of youth ages 10-19 that are eligible uninsured varies from 2.3 percent in Massachusetts to 17.8 percent in Texas (Figure 1).

Figure 1: Percentage of Youth Ages 10-19 That Are Eligible Uninsured by State, 2011⁶