National Expansion of Dental Insurance Among Young Adults: A Natural Experiment

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 DESCRIPTION (provided by applicant): National health reforms relating to the Affordable Care Act have devoted little attention to oral health despite the importance of oral health to overall health, particularly for children and younger adults. A key factor in improving oral health is expanding access to preventive and curative dental care. Expanding access to care often occurs through increased access to dental insurance coverage. Despite limited attention, one of the early policy changes due to the Affordable Care Act has had a spillover effect on dental insurance coverage. The dependent coverage mandate requiring private health insurance plans to allow dependents up to the age of 26 to remain on parental health insurance plans has resulted in young adults gaining access to private dental coverage as well. Coverage rates have increased by as much as 6-7 percentage points, providing dental coverage to nearly 2 million young adults nationwide. This national expansion of private dental insurance provides a unique and unprecedented opportunity of a natural experiment to study the effects of a policy-driven expansion in dental insurance on preventive and curative dental services utilization and dental spending. Previous studies that have contributed to the topic of dental insurance and dental services use have typically focused on public coverage or have suffered from confounding that detracts from the ability to understand the casual effects of dental insurance rather than differences in socioeconomic or demographic traits. In contrast, the private expansion of dental insurance resulting from the dependent coverage mandate was specific to a select group of young adults and took effect in late 2010. In combination, these factors allow for an analysis of dental coverage that can uncover the causal effects of coverage on dental services utilization and overall spending. The proposed study will identify the impacts of the ACA-driven expansion in private dental coverage on utilization of preventive and curative dental services as well as dental spending among young adults. This study is highly innovative as it takes advantage of nationwide expansion of private dental coverage, a natural experiment that can contribute important knowledge about potential future policies directed at increasing dental insurance coverage and the implications for access to dental care. We plan to evaluate preventive, curative, and emergency room dental visits to provide a comprehensive assessment of the effects of the ACA policy and the resulting private dental coverage expansion on dental services utilization and evaluate potential heterogeneity by race/ethnicity, income levels, and rural/urban status. We will use a nationally representative dataset to accomplish the proposed Specific Aims.