Person Mandates

VII. Key Issues: Regulation & Reform >> B. Health Care Regulation >> Health Insurance Regulation >> Person Mandates (last updated 1.17.16)

Topic Outline

1 Overview
2 Analysis of Specific Mandates

Overview

Person mandates simply require coverage of identifiable groups, including adopted children, dependent students, handicapped dependents, newborns, non-custodial children and young adult dependents. By convention, requirements to permit conversion of coverage to non-group policies also are considered person mandates. Also by convention, these mandates do not include mandates for selected services targeted at a particular population such as substance abuse treatment, 48-hour maternity stays or mammography screening. They are restricted to instances in which an entire group receives the same array of coverage as others, not just individual services. With the except of conversion to non-group, which sometimes takes the form of a mandated offering (plans must offer it, but not every plan sold must include this feature), all person mandates require the inclusion of coverage for all plans sold. The Duke Center for Health Policy has developed a draft working paper on the benefits and costs of person mandates: (pdf).

Analysis of Specific Mandates

Denial of Coverage Prohibited for Health Care Services to Persons with an Elevated Blood Alcohol Content

CT Mandate. 2010 Vol. III report estimates this increases group premiums by 0.01% (excludes administrative load)

Newborn Infants

CT Mandate. 2010 Vol. II report estimates this increases group premiums by 1.70% (excludes administrative load)

Young Adult Dependents

Current Policy

Federal Policy. The Affordable Care Act requires that employer-based insurance plans cover health care expenditures for workers with children 26 years old or younger, effective September 2010. Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 under the Patient Protection and Affordable Care Act; Interim Final Rule and Proposed Rule. (2010, May 13).
State Policy.
- NCSL. Covering Young Adults Through Their Parents’ or Guardians’ Health Policy. Detailed summary of state laws prior to and after ACA requirement took effect in September 2010.
- Kronstadt, Jessica, Safiya Mojerie, and Sonya Schwartz. 2007. “State Efforts to Extend Dependent Coverage for Young Adults.” State Health Policy Monitor 1(5).
- Goda, Gopi Shah, Monica Farid, Jay Bhattacharya. The Incidence of Mandated Health Insurance: Evidence from the Affordable Care Act Dependent Care Mandate. NBER Working Paper No. 21846, Issued in January 2016. 37 states had mandates prior to the ACA, the earliest being Utah (1995), but most being post-2005. See Table 1. States with Dependent Coverage Mandates Prior to ACA and Assumed Effective Date.

Research and Analysis

Antwi, Yaa, Asako Moriya, and Kosali Simon. 2013. “Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act’s Dependent-Coverage Mandate.” American Economic Journal: Economic Policy 5(4): 1-28.
Antwi, Yaa, Asako Moriya, and Kosali Simon. 2015. “Access to Health Insurance and the Use of Inpatient Medical Care: Evidence from the Affordable Care Act Young Adult Mandate.” Journal of Health Economics 39: 171-187.
Bailey, James, and Briggs Depew. 2014. “Did the Affordable Care Act’s Dependent Coverage Mandate Increase Premiums?” Journal of Health Economics 41: 1-15.
Barbaresco, Silvia, Charles 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.
Blum, Alexander, Lawrence Kleinman, Barbara Starfield, and Joseph Ross. 2012. “Impact of State Laws that Extend Eligibility for Parents’ Health Insurance Coverage to Young Adults.” Pediatrics 129(3): 426-432.
Cantor, Joel, Dina Belloff, Alan C. Monheit, Derek DeLia, and Margaret Koller. 2012a. “Expanding Dependent Coverage for Young Adults: Lessons from State Initiatives.” Journal of Health Politics, Policy and Law 37(1): 99-128.
Cantor, Joel, Derek DeLia, Kristen Lloyd, and Alan Monheit. 2012b. “Early Impact of the Affordable Care Act on Health Insurance Coverage of Young Adults.” Health Services Research 47(5): 1773-1790.
Chua, Kao-Ping, and Benjamin Sommers. 2014. “Changes in Health and Medical Spending Among Young Adults under Health Reform.” Journal of the American Medical Association 311(23): 2437-2439.
Collins, Sara R., Tracy Garber and Ruth Robertson. 2011. “Realizing Health Reform’s Potential: How the Affordable Care Act is Helping Young Adults Stay Covered.” The Commonwealth Fund.
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.
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.
Fronstin, Paul. 2013. Mental Health, Substance Abuse, and Pregnancy: Health Spending Following the PPACA Adult-Dependent Mandate. Employee Benefit and Research Institute Issue Brief 385.
Goda, Gopi Shah, Monica Farid, Jay Bhattacharya. The Incidence of Mandated Health Insurance: Evidence from the Affordable Care Act Dependent Care Mandate. NBER Working Paper No. 21846, Issued in January 2016. “we find that workers at firms with employer-based coverage – whether or not they have dependent children – experience an annual reduction in wages of approximately $1,200. Our results imply that the marginal costs of mandated employer-based coverage expansions are not entirely borne only by the people whose coverage is expanded by the mandate.”
Golberstein, Ezra, William Beardslee, Susan Busch, Shelly Greenfield, Ellen Meara, Rebecca Zaha. 2014. “Effect of the Affordable Care Act’s Young Adult Insurance Expansions on Hospital-Based Mental Health Care.” The American Journal of Psychiatry 172(2): 182- 189.
Heim, Bradley, Ithai Lurie, and Kosali Simon. 2015. “The Impact of the Affordable Care Act Young Adult Provision on Labor Market Outcomes: Evidence from Tax Data.” In Brown, Jeffrey R. (ed.) Tax Policy and the Economy, 29. University of Chicago Press: December 2015.
Levine, Phillip, Samantha Heep, and Robin McKnight. 2011. “How Effective Are Public Policies to Increase Health Insurance Coverage among Young Adults?” American Economic Journal: Economic Policy 3(1): 129-156.
Monheit AC, Cantor JC, DeLia D, Belloff D. How have state policies to expand dependent coverage affected the health insurance status of young adults? Health Services Research 2011;46:251-67.
Mulcahy, Andrew, Kenneth Finegold, Katherine Harris, Arthur Kellerman, Lauren Edelman, and Benjamin Sommers. 2013. “Insurance Coverage of Emergency Care for Young Adults under Health Reform.” New England Journal of Medicine 368: 2105-2112.
Sommers, Benjamin, Thomas Buchmueller, Sandra 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(1): 165-174.
Sommers, Benjamin, and Richard Kronick. 2012. “The Affordable Care Act and Insurance Coverage for Young Adults.” Journal of the American Medical Association 307(9): 913-914.