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Prev Med. 2019 Dec;129:105863. doi: 10.1016/j.ypmed.2019.105863. Epub 2019 Oct 17.

The effects of the dependent coverage provision on young women's utilization of sexual and reproductive health services.

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Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, United States of America. Electronic address:


The Affordable Care Act dependent coverage provision expanded insurance for young adults by allowing maintained coverage through a parent's plan until the age of 26. This study examines whether this provision was associated with changes in sexual and reproductive health service utilization among young adult women, and if effects differed by race/ethnicity. The National Survey of Family Growth data were used to examine utilization among women before (2006-2009) and after (2011-2013) enactment of the provision. A difference-in-differences model was used to evaluate the effects on four measures of sexual and reproductive health services and one measure of health insurance coverage, treating women 19-25 years old as the exposure group and women 27-34 years old as the control group. This study finds that the dependent coverage provision was associated with a significant decrease in the probability of lacking health insurance, but finds no effects on sexual and reproductive health service utilization overall. In stratified models, increases in receipt of birth control prescriptions and methods as well as birth control check-ups or tests were present only for Hispanic women. There were no significant effects on birth control counseling or information or STD service utilization for any groups. Lacking health insurance coverage decreased only among non-Hispanic White women and Hispanic women, but was not significant for non-Hispanic Black women. These results suggest that women's utilization of sexual and reproductive health services overall may not increase with parental insurance gains, but Hispanic women do increase utilization of some birth control services with this improved coverage.


Health services accessibility; Healthcare disparities; Patient Protection and Affordable Care Act; Reproductive health; Women's health services

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