THURS-021 - Evaluating ACA Dependent Coverage Expansion for Nicotine-cannabis Related Emergency Department Visits Among Young Adults

Brief Abstract Summary: Gain insight into how the Affordable Care Act’s (ACA) dependent coverage expansion impacted emergency department (ED) visits related to nicotine and cannabis use among young adults. Using national ED data from 2007 to 2020, this study examines whether increased insurance access changed the ED utilization patterns and inpatient admissions. While the ACA dependent coverage expansion increased private insurance access for young adults, disparities in ED use and hospital admissions persisted. Cannabis related visits initially favored younger adults but declined post-ACA, while nicotine-related visits rose across all groups. Attendees will explore how expanded insurance access does not guarantee equitable care and why equity-focused interventions remain essential. This session highlights evidence on health policy and substance use, offering insights to address access gaps and improve outcomes for vulnerable young adults through targeted public health strategies.

Detailed abstract description: Substance use among young adults remains a critical public health challenge, particularly regarding nicotine and cannabis. This study examines how the Affordable Care Act’s (ACA) dependent coverage expansion influenced emergency department (ED) visits and inpatient admissions for nicotine- and cannabis-associated conditions among young adults aged 23–25 (affected by the ACA) compared to a control group aged 27–29 (unaffected). Using a quasi-experimental design, ED utilization patterns were compared before (2007–2009) and after (2011–2020) ACA implementation, excluding 2010 as a transition year. Data from the National Emergency Department Sample (NEDS) included over 3.5 million substance-related ED visits. Difference-in-differences regression models estimated the policy’s impact, adjusting for insurance type, income, region, and rural status.

Results show that ED visits for cannabis and nicotine steadily increased across all age groups following the ACA, with more pronounced rises for nicotine. Prior to the ACA, 23–25-year-olds were more likely than 27–29-year-olds to present for cannabis-related issues (p < .001); this gap narrowed post-ACA (p < .001). For nicotine, younger adults were initially less likely to visit EDs (p < .001), but this disparity decreased over time (p < .001), reflecting rising use in both age groups.

The ACA significantly altered the financial payer mix for emergency department visits by expanding Medicaid and reducing the uninsured population. Despite these changes, disparities in inpatient admissions persisted. Young adults aged 23–25 were more likely to be admitted following ED visits post-ACA; however, Medicaid and uninsured patients remained significantly less likely than privately insured peers to be admitted, indicating ongoing care barriers despite expanded coverage.

These findings suggest that coverage expansion alone may not suffice to eliminate structural barriers for high-risk populations. Limited access to quality behavioral health services, stigma, and reimbursement gaps continue to impede equitable healthcare delivery.

For public health practice, these results underscore the need for targeted outreach to support uninsured and underinsured young adults beyond ED settings, emphasizing prevention and sustained treatment. Culturally tailored, health-literate messaging can reduce stigma and promote care-seeking, particularly in underserved communities. Education programs should highlight the effects of health policies like the ACA while equipping future educators with systems-level skills to advocate for equitable, integrated care. Overall, these findings support inclusive, prevention-focused health education strategies to address nicotine- and cannabis-related harms among young adults.