Did the Affordable Care Act's Dependent Coverage Expansion Affect Race/Ethnic Disparities in Health Insurance Coverage?

Abstract

Health reform efforts, such as the DCE, can have negative effects on race/ethnic disparities, despite positive impacts in the general population.

Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010–2015

“…While the current study did not longitudinally assess changes that might have occurred with insurance expansions, the lack of PC-provided mental health services within Black and Latino populations in the face of increased access to primary care services raises concerns. Our findings are somewhat aligned with a prior study of health insurance coverage conducted by Breslau and his colleagues in which racial/ethnic minorities did not equally benefit from the ACA provision that allowed children to stay on a parent’s health insurance plan through age 26 [ 65 ]. Findings from the current study suggest the need for vigilance as to whether important opportunities to assess, diagnose, and coordinate care for Black and Caribbean Latino patients are being adequately addressed or missed in the PC setting [ 66 ].…”

“…The extent to which primary care will serve as an effective source for mental health services for racial/ethnic minorities remains uncertain. As health reforms continue to evolve, attention to racial, ethnic, and cultural factors that promote or limit the delivery of mental health services for specific minority groups is needed to ensure that any proposed changes do not inadvertently contribute to a worsening of mental health disparities [ 65 ].…”

[Job] Locked and [Un]loaded: The effect of the Affordable Care Act dependency mandate on reenlistment in the U.S. Army

“…We test for heterogeneous treatment effects across gender, race, and education levels to examine whether specific populations within our data respond differently to the ACA dependent mandate, since racial minorities and lower-income families are less likely to be covered by employer-sponsored insurance. (Lillie-Blanton and Hoffman, 2005;Card et al, 2008), and Breslau et al (2018) show that white parents are more likely to have health insurance than black parents. Higher levels of education may allow individuals to use their parents' health insurance to pursue better options outside the military (Courtemanche et al, 2016;Grossman, 1972).…”

Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care

“…R. Collins, R. Robertson, T. Garber, & M. M. Doty, 2012). While the evidence to date suggests that the DCE has been successful in increasing insurance coverage among young adults and in increasing utilization of mental health care(Breslau, Han, Stein, etal., 2017), this study addresses several potential undesired impacts of the policy related not simply to the likelihood service use but to the types of service use affected and the allocation of care in the population. We do not find evidence that the potential adverse impacts of the DCE occurred.…”

“…Third, did the DCE lead to an increase in racial/ethnic disparities in mental health care? There is evidence that the DCE did increase racial/ethnic disparities in insurance coverage, likely due to the fact that only those people whose parents or guardians are privately insured are able to benefit from it(Breslau, Han, Stein, Burns, & Yu, 2017). There is also evidence that removing financial barriers to care can increase rather than decrease disparities in mental health care utilization(Adams et al., 2015).…”