Department of Health Systems and Policy, School of Public Health, University of Medicine and Dentistry, Piscataway, NJ, USA.
Health Serv Res. 2011 Feb;46(1 Pt 2):251-67. doi: 10.1111/j.1475-6773.2010.01200.x. Epub 2010 Nov 5.
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.
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.
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.
年龄在 19 至 29 岁的成年人中，近三分之一没有医疗保险，这是所有年龄段中保险覆盖比例最高的。为了解决这一差距，38 个州已经颁布法律，要求保险公司允许年轻人作为父母计划的受抚养人参保。本文评估了这些法律对年轻人参保的影响。
研究设计/方法/数据：本研究使用了 2000 年至 2008 年《当前人口调查》年度人口附录中年龄在 19 至 29 岁的个人数据。线性概率模型用于获取 19 个早期采用州扩大受抚养人覆盖范围对年轻人保险状况的影响的差分差异估计。这些模型还解决了由于各州非随机颁布扩张政策而导致的政策内生性问题。
各州的年轻受抚养人覆盖政策使受抚养人覆盖范围略有增加，所有年轻人的覆盖范围增加了 1.52 个百分点，与父母同住的 19 至 25 岁年轻人的覆盖范围增加了 3.84 个百分点。这些增加在很大程度上被年轻人以自己名义的雇主赞助保险（ESI）的下降所抵消。年轻人的未参保率没有显著下降。
成年受抚养人覆盖范围的扩大对 ESI 受抚养人参保的影响相对较小，而且似乎产生了降低 ESI 投保人覆盖范围的意外后果。这一政策并没有像政策制定者所希望的那样降低未参保率。联邦扩大受抚养人覆盖范围的改革努力可能会更成功，因为改革将伴随着补贴和登记要求。
