ACA Dependent Coverage Linked to Fewer Alcohol-Related ED Visits Among Young Adults: Refat Rasul Srejon, MPH

In part 1 of an interview, Refat Rasul Srejon, MPH, lead investigator of "ACA Dependent Coverage Extension and Young Adults' Substance-Associated ED Visits," published in the September 2025 issue of The American Journal of Managed Care®, shares the study's inspiration, objectives, and key findings.

He is a doctor of public health candidate at the University of Nevada, Las Vegas.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What motivated you to examine the impact of the ACA on substance use disorder–associated ED visits among young adults?

My research focuses on substance use among young adults. I took a health policy class in fall 2023. During this course, I recognized that young adults are a key target of the ACA dependent coverage expansion, between the ages of 22 and 26. Despite this, they also remain at a particularly high risk for substance misuse and emergency department utilization. This actually led me to question whether improved insurance access actually translated into measurable changes in their substance use–associated ED use.

Also, since [the ACA] often serves as a safety net when outpatient substance use disease care is limited or inaccessible, particularly for this age group. This policy is also well-suited for evaluation through a quasi-experimental design and a large administrative data set, making it a logical choice for analysis.

Could you further explain the primary objectives of your study and the methods used to investigate them?

Our primary objective for this study was to assess whether the ACA dependent coverage expansion changed opioid- and alcohol-associated ED visits and subsequent inpatient admissions among young adults.

What we did here is we used a quasi-experimental difference-in-difference design, with the NEDS [Nationwide Emergency Department Sample] study between the years 2007 and 2019, comparing a treatment group, aged between 23 and 25, affected by the policy, to a comparison group, aged between 27 and 29, which we assume was not affected.

We also adjusted for sex, comorbidities, payers, neighborhood income, rurality, and the location of a hospital region. We used generalized mixed models with hospital random effects and performed robustness checks of the data.

What were the main findings? Were there any that surprised you?

We found mixed effects when we analyzed all the findings. We saw that alcohol-associated ED visits declined more in the treatment group after the ACA implementation. This suggested improved coverage may have reduced some alcohol-related ED use. However, opioid-associated ED visits increased overall and showed no differential change between age groups.

Also, inpatient admission patterns did not shift by age group. We believe the contrast between alcohol and opioid results was notable because it suggested insurance expansion alone doesn't informally reduce all this substance-related acute care use.