This study addresses two key features of the Affordable Care Act (ACA) that especially affect young adults, the young adult dependent coverage (YADC) mandate and the requirement to cover contraception. Both mandates were first enacted at the state level during the decade or so preceding the ACA and these state mandates have been studied in past research.  Yet, existing research has evaluated each one in isolation and has not considered its effects in a comprehensive way, from health insurance coverage to routine care received to health outcomes including fertility.

Prior research on YADC mandates focused strictly on insurance coverage and has not found a robust effect, whereas research on contraception coverage's effect on fertility shows a significant decline in births.  We first consider the role of the mandates on coverage. Using an alternative data source, the Behavioral Risk Factor Surveillance Survey (BRFSS), we confirm prior sensitive results by finding no significant effects of the YADC mandate on coverage. We also find no effect for the contraception mandate.

With respect to routine care such as physician visits and pap smears, models of each mandate's effect on annual checkups do not indicate any effect.  However, when allowing for a full interaction there is a significant increase in these measures of care among the population eligible for extended parental coverage in dual mandate states, and an analogous increase in reports of 'Very Good or Excellent' health status.  Using restricted-use Vital Statistics data to analyze fertility outcomes, we confirm the documented decline in fertility (births and abortions) associated with the contraception mandate, as well as find a statistically significant decline in births for models of the YADC mandate.  Although the set of models controlling for both mandates and allowing for an interaction effect suggest that the decline is driven by the contraception mandate, there is evidence of an overlapping role of the mandates working in tandem.