The Impact of the Affordable Care Act in Puerto Rico

Was the Affordable Care Act (ACA) effective in the U.S. territories? This paper explores this question by examining the impact of the ACA's dependent mandate and Medicaid expansion in Puerto Rico. The dependent mandate led to a 4.3 percentage point increase in health insurance coverage for Puerto Rican young adults due to increased employer-sponsored insurance coverage, and the Medicaid Expansion increased Medicaid coverage by 2.4 percentage points. The impact of both policies in Puerto Rico is smaller than in the mainland, highlighting the importance of considering how federal legislation affects territories with economic and health environments dissimilar to the mainland.