Article Title

Contraceptive Choice After the Affordable Care Act

Publication Date



health reform, maternal and child health


Background/Aims: The Affordable Care Act (ACA) mandated that, starting in late 2012, private health insurance plans that are not exempt or grandfathered were required to cover all contraceptive methods approved by the U.S. Food and Drug Administration as prescribed for women without a patient copayment. This policy has the potential to save billions in health care expenditures by reducing the number of unintended pregnancies, thereby reducing the number of deliveries and elective abortions. This study investigated the effect of the ACA-induced change in cost-sharing for contraceptive care on the rate of contraceptive use, the choice between long- and short-term contraceptive methods and the probability of elective abortion.

Methods: We used longitudinal health insurance claims data on female enrollees 18–45 years old (N = 29,990) in insurance plans obtained through 499 employer groups with at least 50 enrollees. Medical and pharmacy claims from 2008 through 2014 were extracted for the sample. Our control group was women covered by the employers who had not yet complied with the ACA-mandated cost sharing as of the end of 2014. We modeled their contraceptive choice using a multinomial probit regression with individual random effects to control for the woman’s time-invariant unobserved characteristics. In a second regression, we modeled elective abortion using a binary probit regression with random effects.

Results: We found that when the copay for contraceptives fell to $0 for those in compliant plans, contraceptive use rose substantially more than for those in noncompliant plans. Moreover, the mandate has increased the probability that a woman chose a long-term contraceptive method above and beyond the general increasing trend for these methods. We also observed a marginally significant decline in elective abortions.

Conclusion: These findings suggest that women are price-sensitive with regard to contraception choice, and thus the ACA mandate will likely significantly reduce the rate of unintended pregnancy. Because unwanted pregnancy is associated with poor birth outcomes, this policy also has the potential to reduce the fraction of high-cost births and children in poor health.




July 5th, 2016


August 12th, 2016