Health insurance coverage and health care utilization: Evidence from the Affordable Care Act’s dependent coverage mandate
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Barış K. Yörük
Abstract
This paper investigates the impact of the Affordable Care Act’s (ACA’s) dependent coverage mandate on health insurance coverage rates and health care utilization among young adults. Using data from the Medical Panel Expenditure Survey, I exploit the discontinuity in health insurance coverage rates at age 26, the new dependent coverage age cutoff enforced by the ACA. Under alternative regression discontinuity design models, I find that 2.5 to 5.3 percent of young adults lose their health insurance coverage once they turn 26. This effect is mainly driven by those who lose their private health insurance plan coverage and those who lose their health insurance plan coverage, whose main holder resides outside of the household. I also find that the discrete change in health insurance coverage rates at age 26 is associated with up to a 3.6 percentage point decrease in office-based physician and and up to a 2.1 percentage point decrease in dental visits, but does not have a significant impact on the utilization of outpatient or emergency department services. Furthermore, the effects of the ACA’s dependent coverage mandate on health care spending and out-of-pocket costs are insignificant. These results are robust under alternative model specifications.
Acknowledgements
I thank Marcus Dillender and session participants at the 6th biennial conference of American Society of Health Economists (2016) and the Annual Meeting of the American Economic Association (2017) for helpful comments. All errors remain mine.
Appendix A
Placebo test: RD models with alternative age cutoffs.
| Age cutoff | ||
|---|---|---|
| 25 | 27 | |
| Any insurance | 0.005 | 0.001 |
| (0.010) | (0.010) | |
| Private insurance | −0.001 | −0.003 |
| (0.009) | (0.010) | |
| Public insurance | 0.010 | 0.003 |
| (0.007) | (0.007) | |
| Holder outside of RU | 0.009*** | −0.004 |
| (0.003) | (0.005) | |
| No. of obs. | 73170 | 73842 |
All regressions contain a quadratic polynomial of the forcing variable which is fully interacted with the treatment. In all regressions, sample weights are used and standard errors are clustered by the forcing variable. Standard errors are reported in parentheses. The sign *** denote statistical significance at 1 percent.
Distribution of the Number of Observations by Month. Notes: Number of observations for each month three years before and after the 26th birthday is plotted.
The Change in Selected Control Variables at the 26th Birthday.
(A) Excellent health, (B) Ln (Family income), (C) Family size, (D) Advanced degree, (E) Married, and (F) Female. Notes: Mean of the selected control variables for 1 month intervals two years before and after the 26th birthday are plotted. The solid lines are the first and second order polynomials fitted on individual observations on both sides of the age-26 cutoff.
Probability of Using Health Care Up to Six Months before the 25th, 26th, and 27th Birthdays.
(A) Office, (B) Emergency department, (C) Outpatient, and (D) Dentist.
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