Rutgers University.
J Health Polit Policy Law. 2012 Feb;37(1):99-128. doi: 10.1215/03616878-1496056.
The Patient Protection and Affordable Care Act (ACA) requires that adults up to age twenty-six be permitted to enroll as dependents on their parents' health plans. This article examines the experiences of states that enacted dependent expansion laws. Drawing on public information from thirty-one enacting states and case studies of four diverse reform states, it derives lessons that are pertinent to the implementation of this ACA provision. Dependent coverage laws vary across the states, but most impose residency, marital status, and other restrictions. The federal Employee Retirement Income Security Act further limits the reach of state laws. Eligibility for expanded coverage under the ACA is much broader. Rules in some states requiring or allowing separate premiums for adult dependents may also discourage enrollment compared with rules in other states (and the ACA), where these costs must be factored into family premiums. Business opposition in some states led to more restrictive regulations, especially for how premiums are charged, which in turn raised greater implementation challenges. Case study states did not report substantial young adult dependent coverage take-up, but early enrollment experience under ACA appears to be more positive. Long-term questions remain about the implications of this policy for risk pooling and the distribution of premium costs.
《患者保护与平价医疗法案》（ACA）要求 26 岁以下的成年人可以作为其父母健康计划的受抚养人参加保险。本文考察了实施了受抚养人扩围法律的各州的经验。利用来自 31 个实施州的公共信息和四个不同改革州的案例研究，本文得出了与该 ACA 条款实施相关的经验教训。各州的受抚养人覆盖法律各不相同，但大多数州都规定了居住、婚姻状况和其他限制。《联邦雇员退休收入保障法案》进一步限制了州法律的适用范围。ACA 规定的扩大覆盖范围的资格要广泛得多。一些州的规定要求或允许为成年受抚养人单独缴纳保费，这可能会与其他州（和 ACA）的规定相比，导致参保率下降，因为这些费用必须计入家庭保费。一些州的企业反对导致了更严格的规定，特别是在保费收取方面，这反过来又带来了更大的实施挑战。案例研究州没有报告大量年轻成年受抚养人参保，但 ACA 下的早期参保经验似乎更为积极。关于该政策对风险分担和保费成本分配的影响，长期问题仍然存在。
