Eastern Economic Journal

, Volume 45, Issue 1, pp 58–86 | Cite as

Impact of the ACA’s Dependent Coverage Mandate on Health Insurance and Labor Market Outcomes Among Young Adults: Evidence from Regression Discontinuity Design

  • Barış K. Yörük
  • Linna XuEmail author
Original Article


This paper identifies the effect of the Affordable Care Act’s dependent coverage mandate on health insurance coverage and labor market outcomes among young adults by exploiting the discrete change in health insurance coverage at age 26. Using a regression discontinuity design, we find that aging out from the ACA’s dependent coverage mandate is associated with up to a 4.2-percentage-point decrease in private insurance coverage at age 26. We also find that aging out from the mandate is significantly associated with an increase in the probability of being employed. However, we do not find any significant changes in hourly wage, weekly working hours or job mobility at age 26.

JEL Classification

I13 I180 J38 


Health insurance ACA’s dependent coverage mandate Employment Job mobility Regression discontinuity design 



We thank the participants in the special session at Eastern Economic Association 44th Annual Conference at Boston, MA, and three anonymous referees for their valuable and helpful comments.


  1. Anderson, Michael, Carlos Dobkin, and Tal Gross. 2012. The Effect of Health Insurance Coverage on the Use of Medical Services. American Economic Journal: Economic Policy 4(1): 1–27.Google Scholar
  2. Antwi, Yaa A., Asako S. Moriya, and Kosali I. Simon. 2013. Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act Dependent Coverage Mandate. American Economic Journal: Economic Policy 5(4): 1–28.Google Scholar
  3. Bailey, James. 2017. Health Insurance and the Supply of Entrepreneurs: New Evidence from the Affordable Care Act. Small Business Economics 3: 627.Google Scholar
  4. Bailey, James, and Anna Chorniy. 2016. Employer-Provided Health Insurance and Job Mobility: Did the Affordable Care Act Reduce Job Lock? Contemporary Economic Policy 34(1): 173–183.Google Scholar
  5. Barbaresco, Silvia, Charles J. Courtemanche, and Yanling Qi. 2015. Impacts of the Affordable Care Act Dependent Coverage Provision on Health-Related Outcomes of Young Adults. Journal of Health Economics 40: 54–68.Google Scholar
  6. Cantor, Joel C., Alan C. Monheit, Derek DeLia, and Kristen Lloyd. 2012. Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults. Health Services Research 47(5): 1773–1790.Google Scholar
  7. Colman, Gregory, and Dhaval Dave. 2018. It’s about Time: Effects of the Affordable Care Act Dependent Coverage Mandate on Time Use. Contemporary Economic Policy 36(1): 44.Google Scholar
  8. Dahlen, Heather M. 2015. “Aging Out” of Dependent Coverage and the Effects on Us Labor Market and Health Insurance Choices. American Journal of Public Health 105: S640–S650.Google Scholar
  9. Depew, Briggs. 2015. The Effect of State Dependent Mandate Laws on the Labor Supply Decisions of Young Adults. Journal of Health Economics 39: 123–134.Google Scholar
  10. Dillender, Marcus. 2014. Do More Health Insurance Options Lead to Higher Wages? Evidence from States Extending Dependent Coverage. Journal of Health Economics 36: 84–97.Google Scholar
  11. Ertan Yörük, Ceren. 2015. The Effect of Alcohol Consumption on Labor Market Outcomes of Young Adults: Evidence from Minimum Legal Drinking Age Laws. B.E. Journal of Economic Analysis & Policy 15(3): 1297.Google Scholar
  12. Fairlie, Robert W., Kanika Kapur, and Susan Gates. 2011. Is Employer-Based Health Insurance a Barrier to Entrepreneurship? Journal of Health Economics 30: 146–162.Google Scholar
  13. Gelman, Andrew, and Guido Imbens. 2014. Why High-Order Polynomials Should Not Be Used in Regression Discontinuity Designs. NBER working paper no. 20405. ​
  14. Gruber, Jonathan, and Brigitte C Madrian. 2002. Health Insurance, Labor Supply, and Job Mobility: A Critical Review of the Literature. NBER working papers, February, 1.
  15. Hahn, Jinyong, Petra Todd, and Wilbert van der Klaauw. 2001. Identification and Estimation of Treatment Effects with a Regression-Discontinuity Design. Econometrica 1: 201–209.Google Scholar
  16. Himmelstein, David U., Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler. 2005. Illness and Injury as Contributors to Bankruptcy. Health Affairs 24(Suppl 1): W5-63–W5-73.Google Scholar
  17. Holahan, J., and G. Kenney. 2008. Health Insurance Coverage of Young Adults. American Community Survey Briefs (September), 6.Google Scholar
  18. Kirzinger, Whitney K., Robin A. Cohen, and Renee M. Gindi. 2013. Trends in Insurance Coverage and Source of Private Coverage Among Young Adults Aged 19–25: United States, 2008–2012. NCHS data brief, no 137. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  19. Lee, David S., and Thomas Lemieux. 2010. Regression Discontinuity Designs in Economics. Journal of Economic Literature 48(2): 281–355.Google Scholar
  20. Levine, Phillip B., Robin McKnight, and Samantha Heep. 2011. How Effective are Public Policies to Increase Health Insurance Coverage of Young Adults? American Economic Journal: Economic Policy 3(1): 129–156.Google Scholar
  21. Monheit, Alan C., Joel C. Cantor, Derek DeLia, and Dina Belloff. 2011. How have State Policies to Expand Dependent Coverage Affected the Health Insurance Status of Young Adults. Health Services Research 46(1): 251–267.Google Scholar
  22. Slusky, D.J.G. 2013. Revisiting the Labor Effects of the Affordable Care Act. Princeton University Working Paper.Google Scholar
  23. Sommers, Benjamin D., and Richard Kronick. 2012. The Affordable Care Act and Insurance Coverage for Young Adults. Journal of the American Medical Association 307(9): 913–914.Google Scholar
  24. Sommers, Benjamin D., Thomas Buchmueller, Sandra L. Decker, Colleen Carey, and Richard Kronick. 2013. The Affordable Care Act Has Led to Significant Gains in Health Insurance and Access to Care for Young Adults. Health Affairs 32: 165–174.Google Scholar
  25. Wellington, Alison J. 2001. Health Insurance Coverage And Entrepreneurship. Contemporary Economic Policy 19: 465–478.Google Scholar
  26. Yörük, Baris K., and Ceren Ertan Yörük. 2011. The Impact of Minimum Legal Drinking Age Laws on Alcohol Consumption, Smoking, and Marijuana Use: Evidence from a Regression Discontinuity Design Using Exact Date of Birth. Journal of Health Economics 4: 740.Google Scholar

Copyright information

© EEA 2018

Authors and Affiliations

  1. 1.Department of EconomicsUniversity at Albany, SUNYAlbanyUSA
  2. 2.CESifoMunichGermany

Personalised recommendations