A Reevaluation of the Effects of State and Federal Dependent Coverage Mandates on Health Insurance Coverage

Barkowski, Scott and McLaughlin, Joanne Song and Ray, Alex (2018): A Reevaluation of the Effects of State and Federal Dependent Coverage Mandates on Health Insurance Coverage.

Abstract

State governments have been passing laws mandating insurers to allow young adults to stay on their parents' health insurance plans past the age of 19 since the 1970s. These laws were intended to increase coverage, but research has been inconclusive on whether they were successful. We reconsider the issue with an improved approach featuring three key elements: a new, accurate dataset on state mandates; recognition that effects could differ greatly by age due to take up rate differences; and avoidance of endogenous characteristics when identifying mandate eligible young adults. We find the impact of the state mandates was concentrated among the 19 to 22 age group, for which dependent coverage increased sharply by about 6 percentage points. Overall coverage increased by almost 3 percentage points, with the difference explained by crowd out of public insurance. Crowd out of coverage through young adults own jobs was negligible. For those above age 22, we find little evidence of changes in coverage. We incorporate these insights into analysis of the Affordable Care Act (ACA) dependent coverage mandate, showing its effects were focused among those whom were previously ineligible for state mandates, or were eligible but older than 22. We argue the ACA's impact was broader because it had fewer eligibility conditions that implied parental dependence; young adults could be on their parents' insurance but still be relatively independent.

• Item Type: MPRA Paper
• Language: English
• Keywords: Health Insurance; Dependent Coverage Mandates; Affordable Care Act
• Subjects: H - Public Economics > H1 - Structure and Scope of Government > H11 - Structure, Scope, and Performance of Government; H - Public Economics > H7 - State and Local Government ; Intergovernmental Relations > H75 - State and Local Government: Health ; Education ; Welfare ; Public Pensions; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Abramowitz, Joelle, “Saying, ”I Dont”: The Effect of the Affordable Care Act Young Adult Provision on Marriage,” Journal of Human Resources, October 2016, 51 (4), 933– 960.

Acs, Gregory, Stephen H. Long, M. Susan Marquis, and Pamela Farley Short, “Self-Insured Employer Health Plans: Prevalence, Profile, Provisions, and Premiums,” Health A.airs, January 1996, 15 (2), 266–277.

Antwi, Yaa Akosa, Asako S. Moriya, and Kosali Simon, “Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 A.ordable Care Act’s Dependent-Coverage Mandate,” American Economic Journal: Economic Policy, November 2013, 5 (4), 1–28. 3,

Barkowski, Scott and Joanne Song McLaughlin, “In Sickness and in Health: The Influence of State and Federal Health Insurance Coverage Mandates on Marriage of Young Adults in the USA,” Working Paper, Social Science Research Network, January 2018.

Bennefield, Robert, “Comparative Analysis of Health Insurance Coverage Estimates: Data from CPS and SIPP,” Working Paper 9608, U.S. Census Bureau 1996.

Bhandari, Shailesh, “People with Health Insurance: A Comparison of Estimates from Two Surveys,” Working Paper 243, U.S. Census Bureau 2004.

Bitler, Marianne P. and Christopher S. Carpenter, “Health Insurance Mandates, Mammography, and Breast Cancer Diagnoses,” American Economic Journal: Economic Policy, August 2016, 8 (3), 39–68.

Bitler, Marianne P. and Christopher S. Carpenter, “Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates,” Health Services Research, February 2017, 52 (1), 156–175.

Bitler, Marianne P. and Lucie Schmidt, “Utilization of Infertility Treatments: The Effects of Insurance Mandates,” Demography, February 2012, 49 (1), 125–149.

Burgdorf, James R., “Young Adult Dependent Coverage: Were the State Reforms Ef­fective?,” Health Services Research, December 2014, 49 (S2), 2104–2128.

Burgdorf, James R., “Young Adult Dependent Coverage: Were the State Reforms E.ective? A Critique and a Response,” Health Services Research, June 2015, 50 (3), 637–641.

Cantor, Joel C., Alan C. Monheit, Derek DeLia, and Kristen Lloyd, “Early Im­pact of the Affordable Care Act on Health Insurance Coverage of Young Adults,” Health Services Research, October 2012, 47 (5), 1773–1790.

Cantor, Joel C., D. Bello., Alan C. Monheit, Derek DeLia, and M. Koller, “Expanding De­pendent Coverage for Young Adults: Lessons from State Initiatives,” Journal of Health Politics, Policy and Law, January 2012, 37 (1), 99–128.

Depew, Briggs, “The effect of state dependent mandate laws on the labor supply decisions of young adults,” Journal of Health Economics, January 2015, 39, 123–134.

Dillender, Marcus, “Do more health insurance options lead to higher wages? Evidence from states extending dependent coverage,” Journal of Health Economics, July 2014, 36, 84–97.

Flood, Sarah, Miriam King, Steven Ruggles, and J. Robert Warren, “Integrated Public Use Microdata Series, Current Population Survey: Version 5.0.,” Technical Report, University of Minnesota, Minneapolis 2017.

Gabel, Jon R., Gail A. Jensen, and Samantha Hawkins, “Self-Insurance In Times Of Growing And Retreating Managed Care,” Health Affairs, March 2003, 22 (2), 202–210.

Gamino, Aaron, “New Evidence on the Effects of Dependent Coverage Mandates,” Working Paper, Social Sciences Research Network, March 2018.

Gruber, Jonathan, “The Incidence of Mandated Maternity Benefits,” The American Economic Review, 1994, 84 (3), 622–641.

Hahn, Youjin and Hee-Seung Yang, “Do Work Decisions among Young Adults Respond to Extended Dependent Coverage?,” ILR Review, May 2016, 69 (3), 737–771.

Ham, John C. and Lara Shore-Sheppard, “The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP,” Journal of Public Economics, January 2005, 89 (1), 57–83.

Hamersma, Sarah and Matthew Kim, “Participation and crowd out: Assessing the effects of parental Medicaid expansions,” Journal of Health Economics, January 2013, 32 (1), 160–171.

Jensen, Gail A., Kathryn Rost, Russell P.D. Burton, and Maria Bulycheva, “Mental health insurance in the 1990s: are employers offering less to more?,” Health A.airs, May 1998, 17 (3), 201–208.

Levine, Phillip B, Robin McKnight, and Samantha Heep, “How Effective are Public Policies to Increase Health Insurance Coverage Among Young Adults?,” American Economic Journal: Economic Policy, February 2011, 3 (1), 129–156.

Monheit, Alan C., Joel C. Cantor, and Derek DeLia, “Drawing Plausible Inferences about the Impact of State Dependent Coverage Expansions,” Health Services Research, June 2015, 50 (3), 631–636.

Monheit, Alan C., Joel C. Cantor, and Derek DeLia, and Dina Bello., “How Have State Policies to Expand Dependent Cover­age A.ected the Health Insurance Status of Young Adults?,” Health Services Research, February 2011, 46 (1p2), 251–267.

Pascale, Joanne, Michel Boudreaux, and Ryan King, “Understanding the New Current Population Survey Health Insurance Questions,” Health Services Research, February 2016, 51 (1), 240–261.

Pierron, William L. and Paul Fronstin, “ERISA Pre-emption: Implications for Health Reform and Coverage,” Technical Report 314, Employee Bene.t Research Institute February 2008.

Ruggles, Steven, Katie Genadek, Ronald Goeken, Josiah Grover, and Matthew Sobek, “Integrated Public Use Microdata Series, American Community Survey: Version 5.0.,” Technical Report, University of Minnesota, Minneapolis 2017.

Schmidt, Lucie, “Effects of infertility insurance mandates on fertility,” Journal of Health Economics, May 2007, 26 (3), 431–446.

Sommers, Benjamin D. and Richard Kronick, “The Affordable Care Act and Insurance Coverage for Young Adults,” JAMA, March 2012, 307 (9).

Sommers, Benjamin D., Thomas Buchmueller, Sandra L. Decker, Colleen Carey, and Richard Kronick, “The Affordable Care Act Has Led To Signi.cant Gains In Health Insurance And Access To Care For Young Adults,” Health A.airs, January 2013, 32 (1), 165–174.

StataCorp, “Stata Statistical Software: Release 13.1,” 2013.

Swartz, Katherine, “Interpreting the estimates from four national surveys of the number of people without health insurance,” Journal of Economic and Social Measurement, 1986, 14 (3), 233–242.

Trudeau, Jennifer and Karen Smith Conway, “The Effects of Young Adult-Dependent Coverage and Contraception Mandates on Young Women,” Contemporary Economic Policy, January 2018, 36 (1), 73–92.

U.S. Bureau of the Census, “Current Population Survey, ASEC Technical Documentation,” 2005.