Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of the Affordable Care Act (ACA) dependent coverage mandate on employer benefits receipt, public benefits receipt, and employment.
- The study used a difference-in-differences design to estimate the impact of the ACA's dependent coverage mandate using data from the National Health Insurance Survey (NHIS). The authors used a statistical model to compare outcomes for individuals aged 19-25 and those aged 26-32 before and after the ACA’s dependent coverage mandate was implemented.
- The study found a positive statistically significant relationship between the ACA’s dependent coverage mandate and employer benefits receipt.
- This study receives a moderate evidence rating. This means we are somewhat confident that the estimated effects are attributable to the Affordable Care Act’s dependent coverage mandate, but other factors might also have contributed.
Intervention Examined
The Affordable Care Act dependent coverage mandate
Features of the Intervention
The Affordable Care Act (ACA) dependent coverage mandate expanded access to insurance by allowing young adults to remain on their parent’s employer-sponsored insurance (ESI) as a dependent child until age 26. Before 2010, young adults would lose their dependent-child ESI at age 19, or 23 if they were full-time students.
Features of the Study
The study used a difference-in-differences design to estimate the impact of the ACA dependent coverage mandate on employer benefits receipt, public benefits receipt, and employment. The treatment group includes individuals aged 19 to 25 who were eligible for the mandate and the comparison group includes individuals aged 26 to 32 who were not eligible.
The treatment group received access to expanded health insurance coverage through the ACA’s dependent coverage mandate, allowing them to continue receiving their parents’ ESI until age 26. The comparison group did not have continued access to their parents’ ESI since the dependent coverage mandate was implemented after they reached the age cutoff.
Outcomes were measured from 2011-2013, the first three years after the ACA dependent coverage mandate was implemented. The author used data from the National Health Insurance Survey (NHIS) from 2004 to 2013. The NHIS is an annual survey of households that gathers information on health insurance coverage by payers, sources of private insurance, and policyholders.
Findings
Employer Benefits Receipt
- The study found a positive statistically significant relationship between the ACA’s dependent mandate and the share of participants with ESI as a dependent. The study found no statistically significant relationship between the ACA's dependent care coverage mandate and the share of participants with ESI in their own name.
Public Benefits Receipt
- The study found no statistically significant relationship between the ACA’s dependent coverage mandate and the share of participants with public insurance.
Employment
- The study found no statistically significant relationship between the ACA’s dependent coverage mandate and the share of employed participants, the share of participants who worked full-time, the average hours worked per week, and labor force participation.
Considerations for Interpreting the Findings
The author notes that the treatment and comparison groups differ in educational attainment since the treatment group is aged 19 to 25 and is therefore more likely to be in school than the comparison group aged 26 to 32. The differences in educational attainment may lead to differences in employment and ESI coverage. However, the author conducted robustness checks comparing narrow age groups (24-25 vs. 27-28) who are less likely to be in school and found results similar to the main findings.
Causal Evidence Rating
This study receives a moderate evidence rating. This means we are somewhat confident that the estimated effects are attributable to the Affordable Care Act’s dependent coverage mandate, but other factors might also have contributed.