Address correspondence to Joel C. Cantor, Sc.D., Professor and Director, Center for State Health Policy, Rutgers University, 112 Paterson Street, 5th Floor, New Brunswick, NJ 08901; e-mail: firstname.lastname@example.org. Alan C. Monheit, Ph.D., Professor of Health Economics, Department of Health Systems and Policy, School of Public Health, University of Medicine and Dentistry, Piscataway, NJ. Derek DeLia, Ph.D., Associate Research Professor, Dina Belloff, M.A., Senior Research Analyst, are with the Center for State Health Policy, Rutgers University, New Brunswick, NJ.
How Have State Policies to Expand Dependent Coverage Affected the Health Insurance Status of Young Adults?
Article first published online: 5 NOV 2010
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 1p2, pages 251–267, February 2011
How to Cite
Monheit, A. C., Cantor, J. C., DeLia, D. and Belloff, D. (2011), How Have State Policies to Expand Dependent Coverage Affected the Health Insurance Status of Young Adults?. Health Services Research, 46: 251–267. doi: 10.1111/j.1475-6773.2010.01200.x
- Issue published online: 3 JAN 2011
- Article first published online: 5 NOV 2010
- Health care financing;
- health policy;
- health economics
Research Objective. Nearly one in three adults of ages 19–29 lack health insurance, representing the highest uninsured rate of any age group. To help address this gap, 38 states have enacted laws requiring insurers to permit young adults to enroll as dependents on their parents' plans. This paper evaluates their impact on coverage for young adults.
Study Design/Methods/Data. This study uses data for individuals ages 19–29 from the Current Population Survey's Annual Demographic Supplement for calendar years 2000–2008. Linear probability models are used to obtain difference-in-differences estimates of the impact of dependent coverage expansions in 19 early-adopting states on young adults' insurance status. The models also address possible policy endogeneity due to the nonrandom enactment of expansion policies across states.
Principal Findings. State young adult dependent coverage policies yielded small increases in dependent coverage ranging from 1.52 percentage points for all young adults to 3.84 percentage points for those ages 19–25 residing with parents. These increases were largely offset by declines in employer-sponsored insurance (ESI) in the young adults' own name. No significant impact on young adult uninsured rates was observed.
Conclusions and Implications. Adult dependent coverage expansions have had a relatively small impact on enrollment as an ESI dependent and appear to have the unintended consequence of reducing ESI policyholder coverage. This policy did not achieve a reduction in uninsured rates as policy makers had intended. Federal reform efforts to expand dependent coverage are likely to be more successful because reform will be accompanied by subsidies and enrollment mandates.