Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA.
Department of Pediatrics, Harvard Medical School, Boston, MA.
Health Serv Res. 2018 Jun;53(3):1581-1599. doi: 10.1111/1475-6773.12723. Epub 2017 May 30.
To determine the effect of state-level dependent coverage expansion (DCE) with and without other state health reforms on exit from dependent coverage for adolescents and young adults (AYA).
Administrative longitudinal data for 131,542 privately insured AYA in Massachusetts (DCE with other reforms) versus Maine and New Hampshire (DCE without other reforms) across three periods: prereform (1/00-12/06), poststate reform (1/07-9/10), and postfederal reform (10/10-12/12).
A difference-in-differences estimator was used to determine the rate of exit from dependent coverage, age at exit from dependent coverage, and re-uptake of dependent coverage among AYA in states with comprehensive reforms versus DCE only.
Implementation of DCE with other reforms was significantly associated with a 23 percent reduction in exit from dependent coverage among AYA compared to the reduction observed for DCE alone. Additionally, comprehensive reforms were associated with over two additional years of dependent coverage for the average AYA and a 33 percent increase in the odds of regaining dependent coverage after a prior loss.
Findings suggest that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA.
确定州级有条件保险范围扩大（DCE）及其与其他州级卫生改革相结合与不结合对青少年和年轻人（AYA）退出依赖保险的影响。
马萨诸塞州（有其他改革的 DCE）与缅因州和新罕布什尔州（没有其他改革的 DCE）的 131542 名私人投保 AYA 的行政纵向数据，跨越三个时期：改革前（1/00-12/06）、州级改革后（1/07-9/10）和联邦改革后（10/10-12/12）。
使用差异中的差异估计量来确定有全面改革的州的 AYA 退出依赖保险的比率、退出依赖保险的年龄以及重新获得依赖保险的比率，与仅 DCE 相比。
与仅 DCE 相比，实施其他改革的 DCE 与 AYA 退出依赖保险的比例降低 23%显著相关。此外，全面改革还使平均 AYA 的依赖保险期限延长了两年多，并使之前失去依赖保险后重新获得的可能性增加了 33%。
研究结果表明，个人授权和其他改革可能会增强 DCE 在防止 AYA 失去保险方面的效果。
