An Affordable Care Act (ACA) provision that allows young adults to stay on a parent's health insurance plan until age 26 enabled young adults to delay having children and getting married—an effect that policymakers should consider as they debate repealing the law, Joelle Abramowitz writes in The Conversation.
How the provision affected birth, abortion rates
To examine how the provision may have influenced family planning decisions, Abramowitz, an assistant research scientist at the University of Michigan, conducted a recently published study comparing a sample of women affected by the provision before and after the provision's implementation with a control group of slightly younger and slightly older women who were unaffected by the provision.
Abramowitz found that following the provision's enactment, the rate of babies born to women ages 20 to 25 dropped by 10% compared with the control group—a decline not explained by an increase in abortion. Data show that the rate of abortion among women ages 20 to 24 who were able to stay on a parent's insurance dropped by 9 to 14% compared with the rate for women who did not gain coverage eligibility, Abramowitz found.
According to Abramowitz, the decline in the birth and abortion rates may be explained by an increase in the use of long-term hormonal birth control. Usage increased 68% among women affected by the dependent coverage provision compared with the control group. (Abramowitz explains that the relative increase appears large because use of such methods was low before the provision took effect.)
How the provision affected the marriage rate
Abramowitz also cites an earlier study she conducted that assessed whether the dependent coverage provision affected the rate of marriage, based on the hypothesis that people may consider their coverage or lack thereof when deciding to get married. For the study, she examined whether 1.4 million people between the ages of 23 to 25 and 28 to 30 participating in the American Community Survey over 2008 to 2013 had been married or divorced over the prior year, or whether they were living with a partner.
Abramowitz found that young adults ages 23 to 35 by 2013 were 9% less likely to have married compared with the slightly older control group. "This suggests that this provision may enable young adults to make marriage decisions without the added consideration of insurance coverage," Abramowitz writes, adding, "This may allow them to search longer to find spouses who are better matches and form more stable marriages."
Further, according to the data, there was a brief surge in the divorce rate after the dependent coverage provision took effect, as well as a drop in people cohabiting.
Citing the two studies, Abramowitz concludes, "Future changes to the ACA have the potential to further affect major life decisions of eligible individuals, for better or worse. It is important to consider these unintended consequences when evaluating changes to these policies" (Abramowitz, The Conversation, 11/14).
12 things your C-suite needs to know in 2018
Uncertainty abounds—and health systems need to face it head on. Download our new briefing to learn 12 key insights for senior executives working to drive hospital and health system success in 2018.