title: Effects of the Affordable Care Act's Dependent Coverage Mandate on Private Health Insurance Coverage in Urban and Rural Areas.
abstract: To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas.
  
  
  
  A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence.
  
  
  
  Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 percentage points in nonmetropolitan areas (P = .03). These changes were not significantly different from each other (P = .82), which suggests the ACA mandate's effects were not statistically different by area of residence.
  
  
  
  Although young adults in metropolitan and nonmetropolitan areas experienced increased access to private health insurance following the ACA's dependent coverage mandate, it did not appear to directly impact rural-urban disparities in health insurance coverage. Despite residents in both areas gaining insurance coverage, over one-third of young adults still lacked access to full-year health insurance coverage.
authors.affiliation: Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Look
authors.affiliation: Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin.
authors.forename: Nam Hyo
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin.
authors.forename: Prachi
authors.initials: P
authors.lastname: Arora
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005190:Family; D005260:Female; D062489:Health Impact Assessment / Q000379:methods*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data / Q000639:trends*; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Affordable Care Act; health disparities; insurance; policy; rural