Primm, Kristin M (2020-07). Examining the Effect of the Affordable Care Act's Dependent Coverage Provision on Access and Utilization of Behavioral Health Treatment: An Urban Rural Comparison. Doctoral Dissertation.
Thesis
In September 2010, an early provision of the Affordable Care Act (ACA) enabled young adults to remain on their parents' private insurance plans as dependents until the age of 26. The dependent coverage provision (DCP) may have been especially advantageous for rural residents, who have worse insurance coverage and poorer access to health care compared to their urban counterparts. While the DCP expanded insurance coverage and increased healthcare utilization among young adults, its impact on rural residents remains unclear. Study one provides a comprehensive literature review of prior research on the impact of the DCP on young adult`s access to and utilization of health care. Studies so far suggest that the DCP increased young adult`s private insurance coverage, access to a usual source of care, and reduced health care costs. The DCP also increased utilization of some health services, including mental health and dental care. However, the DCP`s impact on other health services such as emergency department visits and hospital stays remains unclear. Notably, very few studies have explored the DCP`s impact on disparities in access to and utilization of health care among rural and underserved populations. The second study used a quasi-experimental approach to compare pre-post DCP changes in access to and utilization of mental health treatment among rural versus urban dwelling young adults (ages 19-25 years versus 26-34 years), using data from the 2007-2014 National Survey on Drug Use and Health. Findings indicated that the magnitude of the DCPs impact on utilization of mental health treatment services among rural young adults was nearly double those of urban young adults (8.77% versus 3.97%). Compared to urban residents, rural young adults experienced greater gains in insurance coverage and were also more likely to use their newly acquired insurance to pay for their mental health treatment. Cost-related barriers to mental health care also declined significantly by 16.77% in rural young adults following the DCP, while urban residents experienced no effect. Similar to study two, the final study used a quasi-experimental approach to estimate the DCP`s effect on access to and utilization of substance use disorder (SUD) treatment services among rural versus urban young adults (ages 19-25 years versus 26-34 years), using data from the 2007-2014 National Survey on Drug Use and Health. While results indicated that both rural and urban experienced gains in private insurance coverage and decreases in financial barriers to care following the DCP, we found no evidence of corresponding increases in SUD treatment utilization. Findings did provide evidence that newly insured rural residents were able to use their private insurance to cover treatment costs, which appeared to impact the setting at which rural residents receive SUD treatment.
