departments (EDs) serving as the "safety net of the safety net" for uninsured patients and Medicaid beneficiaries.^\[[@R10],[@R11]\]^ Consequently, numerous studies have established that young adults utilize ED care for their health related concerns.^\[[@R12]--[@R14]\]^ One study determined that ED care accounts for 21.6% of all healthcare visits from adults 20 to 29, and that between 2005 and 2010, there was a 15% increase in ED visits in California among those 19 to 34.^\[[@R12]--[@R14]\]^ The passage of the EMTALA in conjunction with our changing healthcare system has contributed to the growing volume of ED visits, particularly among young adults.^\[[@R11]--[@R14]\]^

The patient protection and affordable care act (ACA) was signed into law on March 23, 2010, with a primary goal of increasing the number of Americans with health insurance.^\[[@R15]\]^ The dependent coveragedetermined that Medicaid beneficiaries were more likely to have had a least 1 ED visit in a 12-month period than persons with private insurance and the uninsured.^\[[@R32]\]^

By 2014, the coverage for dependent young adults had been established policy for several years and the Medicaid expansion was just taking effect. The national payer mix and ED payer mix changed relative to the pre-ACA period. By 2015, 65% of those 19 to 25 were covered by private insurance, 19% by public insurance and the uninsured had fallen to 16%.^\[[@R24]\]^ These national payer changes were also reflected in the ED utilization. Private insurance was covering 32% of ED visits, public insurance 35% of visits, and uninsured 17% of visits. It is clear that the passage of the ACA did not mitigate