EBRI Issue Brief

Mental Health, Substance Abuse, and Pregnancy: Health Spending Following the PPACA Adult-Dependent Mandate

Apr 11, 2013 16  pages


  • The Patient Protection and Affordable Care Act (PPACA) requires group health plans that offer dependent coverage to make that coverage available to workers’ children until they reach age 26, regardless of student status, marital status or financial support by the employees.
  • A number of studies found measurable increases in the percentage of young adults with employment-based coverage soon after the mandate took effect.
  • It has been estimated that 3.1 million young adults have acquired health coverage as a result of this adult-dependent mandate (ADM) provision.
  • Overall, 31 percent of employers enrolled adult-dependent children as a result of the mandate, although the percentage of employers enrolling adult dependents as a result of the mandate increased with firm size. Larger employers are much more likely than smaller ones to have enrolled young adults as a result of the ADM.
  • With respect to the experience of the specific large employer examined in this analysis, following implementation of the mandate, health care spending increased by $2 million, representing 0.2 percent of total health care spending.
  • Average spending in the ADM cohort was higher than in the comparison group. The ADM cohort used an average of $2,866 in 2011, 15 percent higher than the comparison group, which used $2,472 on average.
  • The most interesting finding related to the types of health care services used by those in the ADM cohort. The ADM cohort was more likely to incur claims related to mental health, substance abuse, and pregnancy.
  • The ADM cohort was more likely than the comparison group to use retail pharmacies rather than mail order. Eighty-three percent of the prescriptions filled by the ADM cohort and 74 percent of the prescriptions filled by the comparison group were filled in retail pharmacies.
  • There were no notable differences between the ADM cohort and the comparison group when use of prescriptions was examined by therapeutic class. Overall, 23 percent of the prescriptions filled for the two groups were for contraceptives. Another 9 percent were for psychostimulants and antidepressants.