Will health care reform reduce disparities in insurance coverage?: Evidence from the dependent coverage mandate

Med Care. 2014 Jun;52(6):528-34. doi: 10.1097/MLR.0000000000000134.


Objectives: We used data from the Medical Expenditure Panel Survey to assess the impact of the Affordable Care Act's dependent coverage mandate on disparities in health insurance coverage rates and evaluated whether non-Hispanic blacks and Hispanics gained coverage at the same rates as non-Hispanic whites.

Methods: To estimate changes in insurance rates, we employed a difference-in-difference regression approach comparing 7962 young adults aged 19-25 to 9321 adults aged 27-34. Separate regressions were estimated for non-Hispanic blacks, Hispanics, and non-Hispanic whites to understand whether the mandate had differential effects by race/ethnicity. Separate regressions by income level and race/ethnicity were also estimated.

Results: Insurance rates increased by 9.3 percentage points among non-Hispanic whites, 7.2 percentage points among Hispanics, and 9.4 percentage points among non-Hispanic blacks. These changes were not significantly different from each other. Among individuals with income of <133% of the Federal Poverty Level, non-Hispanic whites experienced significantly larger gains, whereas at higher-income levels, non-Hispanic blacks experienced significantly larger gains than other racial/ethnic groups.

Conclusions: The dependent coverage mandate of the Affordable Care Act increased insurance rates among all racial and ethnic groups but did not change overall disparities. Disparities may have widened among low-income populations which highlights the importance of Medicaid expansions in reducing disparities. Among higher-income populations, disparities between non-Hispanic blacks and non-Hispanic whites were reduced.

MeSH terms

  • Adult
  • African Americans / statistics & numerical data
  • Female
  • Health Care Reform / legislation & jurisprudence*
  • Health Expenditures / legislation & jurisprudence
  • Health Expenditures / statistics & numerical data
  • Health Services Accessibility / statistics & numerical data
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Insurance Coverage / legislation & jurisprudence*
  • Male
  • Medicaid / legislation & jurisprudence
  • Patient Protection and Affordable Care Act / legislation & jurisprudence*
  • Poverty
  • United States
  • Whites / statistics & numerical data
  • Young Adult