The effect of health insurance on sexual health: Evidence from the Affordable Care Act's dependent coverage mandate

Effects of marriage equality legislation on sexual health of the US population

“…Focusing on married couples, MEL increases the share of same-sex married couples, but it does not lead to significant changes in different-sex marriages (though still positively associated). There is no evidence that marriage legalization is associated with significant changes in the share of PrEP users nor with increased reimbursements for PrEP medications, however, MEL increases per capita reimbursements for HAART.10 Due to smaller sample sizes in the CPS compared to the US Census, omission of LGB individuals without partners or same-sex couples that do not live together(Delhommer & Hamermesh, 2021), and missing information on sex, relationship status, or marital status(Dillender, 2015), the share of same-sex couples measured in the CPS(Kreider & Gurrentz, 2019) may be understated.11 Constructing a measure for the share of same-sex marriages (instead of same-sex relationships) shows that the interaction term is significant only for reducing HIV infections (−0.636*).12 The positive coefficients for non-HIV/AIDS rates are consistent with previous studies showing that increased access to health care may create moral hazard where individuals engage in riskier sexual behaviors(Oney, 2018; Willage, 2020).13 HIV prevalence rates by sexual behavior groups are available for 2008-2019. Repeating the analyses for HIV rates, I find qualitatively similar results to the ones reported in Table5.…”

“…Chlamydia is highly asymptomatic (Oney, 2018) and might be a better proxy for the spread of infections among women since it is almost twice as common among women than men. The infection is still prevalent among the male population, increasing by 32.1% during 2015-2019, which may reflect that the number of MSM has increased, or that availability of PrEP has led to more testing for all STIs.…”

“…I add to these studies by providing evidence that the legislation further decreases infection rates within states with higher tolerance toward LGB individuals, consistent with previous studies (Nikolaou, 2022b). The last strand of the literature focuses on the impact of policies that increase access to health care insurance such as Medicaid expansions (Oney, 2018; Simon et al., 2017), since policies that extend marriage to same‐sex couples can increase investments in sexual health—and improve overall health—by covering medical care for same‐sex partners (Hatzenbuehler et al., 2012). I explicitly show that increased coverage for sexual health screenings leads to even greater reductions in HIV and AIDS rates, while there is some evidence that the beneficial effects of MEL may operate through increased monetary support for treatment of AIDS captured by increased reimbursements for antiretroviral medications 1…”

Unintended consequences of health insurance: Affordable Care Act's free contraception mandate and risky sex

“…One related study by Oney (2018) examines the effect of the 2010 dependent coverage mandate and finds it increase reported cases of STIs for 20-to 24-year-olds compared with people in their late teens or late 20s. Because these health behaviors often do not result in health shocks for many years, we may not expect to see evidence of ex ante moral hazard.…”

“…To overcome this obstacle, I examine risky sex, which has a short lag before resulting in health shocks such as an unintended pregnancy or STI contraction. One related study by Oney (2018) examines the effect of the 2010 dependent coverage mandate and finds it increase reported cases of STIs for 20-to 24-year-olds compared with people in their late teens or late 20s. However, Oney concludes this was not through a change in behavior but through increased STI testing.…”