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In Sickness and in Health: The Influence of State and Federal Health Insurance Coverage Mandates on Marriage of Young Adults in the USA

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  • Barkowski, Scott
  • McLaughlin, Joanne Song

Abstract

We study the effects of state and federal dependent health insurance mandates on marriage rates of young adults, ages 19 to 25. Motivated by low rates of coverage among this age group, state governments began mandating health insurers in the 1970s to allow adult children to stay on their parents’ insurance plans. These state level efforts successfully increased insurance coverage rates, but also came with unintended implications for the marriage decisions of young adults. Almost all state mandates explicitly prohibited marriage as a condition of eligibility, thereby directly discouraging marriage. Additionally, by making access to health insurance through parents easier, the mandates made access through spouses’ employers relatively less attractive. To the extent that young adults were altering their marriage plans to gain access through potential spouses, they no longer needed to do so under the mandates, thereby implicitly discouraging marriage. When the dependent coverage mandate of the Affordable Care Act (ACA) was enacted, it effectively ended the state-based marriage restrictions, thereby encouraging marriage among young adults previously eligible for state mandates. On the other hand, for those who were not eligible for state mandates, the ACA represented an attractive new path to obtain coverage, thereby discouraging marriage for these young adults, just as the state mandates had implicitly done previously for others. Thus, the separate efforts at the state and federal level to address low coverage rates for young adults ended up interacting and influencing incentives for marriage in opposite directions. We study these interaction effects on marriage empirically using a new dataset we compiled on state-level dependent coverage mandates. Consistent with theoretical arguments, we find that, before the implementation of the ACA, state mandates lowered marriage rates by about 2 percentage points, but this pattern reversed upon the passage of the ACA. We also find that state mandates increased the probability of out-of-wedlock births among state-mandate-eligible women as compared to ineligible ones, but the ACA reversed this trend as well. Our study provides an important example where fundamental understanding of the effects of the ACA dependent coverage mandate can only be had with full consideration of the pre-existing state laws.

Suggested Citation

  • Barkowski, Scott & McLaughlin, Joanne Song, 2018. "In Sickness and in Health: The Influence of State and Federal Health Insurance Coverage Mandates on Marriage of Young Adults in the USA," MPRA Paper 84014, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:84014
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    File URL: https://mpra.ub.uni-muenchen.de/84014/1/MPRA_paper_84014.pdf
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    References listed on IDEAS

    as
    1. Youjin Hahn & Hee-Seung Yang, 2016. "Do Work Decisions among Young Adults Respond to Extended Dependent Coverage?," ILR Review, Cornell University, ILR School, vol. 69(3), pages 737-771, May.
    2. Dillender, Marcus, 2014. "Do more health insurance options lead to higher wages? Evidence from states extending dependent coverage," Journal of Health Economics, Elsevier, vol. 36(C), pages 84-97.
    3. Joelle Abramowitz, 2016. "Saying, “I Don’t”: The Effect of the Affordable Care Act Young Adult Provision on Marriage," Journal of Human Resources, University of Wisconsin Press, vol. 51(4), pages 933-960.
    4. Christina M. Gibson-Davis & Elizabeth O. Ananat & Anna Gassman-Pines, 2016. "Midpregnancy Marriage and Divorce: Why the Death of Shotgun Marriage Has Been Greatly Exaggerated," Demography, Springer;Population Association of America (PAA), vol. 53(6), pages 1693-1715, December.
    5. Yaa Akosa Antwi & Asako S. Moriya & 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, American Economic Association, vol. 5(4), pages 1-28, November.
    6. Phillip B. Levine & Robin McKnight & Samantha Heep, 2011. "How Effective Are Public Policies to Increase Health Insurance Coverage among Young Adults?," American Economic Journal: Economic Policy, American Economic Association, vol. 3(1), pages 129-156, February.
    7. Aaron S. Yelowitz, 1998. "Will Extending Medicaid to Two-Parent Families Encourage Marriage?," Journal of Human Resources, University of Wisconsin Press, vol. 33(4), pages 833-865.
    8. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, Oxford University Press, vol. 119(1), pages 249-275.
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    10. Depew, Briggs, 2015. "The effect of state dependent mandate laws on the labor supply decisions of young adults," Journal of Health Economics, Elsevier, vol. 39(C), pages 123-134.
    11. David M. Zimmer, 2007. "Asymmetric Effects Of Marital Separation On Health Insurance Among Men And Women," Contemporary Economic Policy, Western Economic Association International, vol. 25(1), pages 92-106, January.
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    Cited by:

    1. J Matthew Hampton & Otto Lenhart, 2019. "'Til insurance do us part: the effect of the affordable care act preexisting conditions provision on marriage," Working Papers 1902, University of Strathclyde Business School, Department of Economics.
    2. Scott Barkowski & Joanne Song McLaughlin & Alex Ray, 2020. "A Reevaluation of the Effects of State and ACA Dependent Coverage Mandates on Health Insurance Coverage," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(3), pages 629-663, June.
    3. Tianxu Chen, 2019. "Health Insurance and Marriage Behavior: Will Marriage Lock Hold Under Healthcare Reform?," Working papers 2019-10, University of Connecticut, Department of Economics.
    4. Hanming Fang & Andrew J. Shephard, 2019. "Household Labor Search, Spousal Insurance, and Health Care Reform," NBER Working Papers 26350, National Bureau of Economic Research, Inc.

    More about this item

    Keywords

    Marriage; Dependent Health Insurance Mandates; ACA; Health Insurance;

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J11 - Labor and Demographic Economics - - Demographic Economics - - - Demographic Trends, Macroeconomic Effects, and Forecasts
    • J12 - Labor and Demographic Economics - - Demographic Economics - - - Marriage; Marital Dissolution; Family Structure
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth

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