Affordable Care Act’s Mandate Eliminating Contraceptive Cost Sharing Influenced Choices Of Women With Employer Coverage

Abstract

Patient cost sharing for contraceptive prescriptions was eliminated for certain insurance plans as part of the Affordable Care Act. We examined the impact of this change on women's patterns of choosing prescription contraceptive methods. Using claims data for a sample of midwestern women ages 18-46 with employer-sponsored coverage, we examined the contraceptive choices made by women in employer groups whose coverage complied with the mandate, compared to the choices of women in groups whose coverage did not comply. We found that the reduction in cost sharing was associated with a 2.3-percentage-point increase in the choice of any prescription contraceptive, relative to the 30 percent rate of choosing prescription contraceptives before the change in cost sharing. A disproportionate share of this increase came from increased selection of long-term contraception methods. Thus, the removal of cost as a barrier seems to be an important factor in contraceptive choice, and our findings about long-term methods may have implications for rates of unintended pregnancy that require further study.

The Impact of Insurance Coverage on Utilization of Prescription Contraceptives: Evidence from the Affordable Care Act

“…They perform their analysis on a smaller population of women in the upper Midwest, but they also have several additional months of data. The consistency of my results with the results from Carlin, Fertig, and Dowd () suggests that the short‐term effects of the ACA mandate remained stable across insurers and geographic regions.…”

Unintended consequences of health insurance: Affordable Care Act's free contraception mandate and risky sex

“…Between 2012 and 2014, the percent of privately insured women who paid $0 out-of-pocket for contraception increased by 30-50 percentage points across methods (Bearak, Finer, Jerman, & Kavanaugh, 2016;Sonfield, Tapales, Jones, & Finer, 2015). 15 An analysis of 499 Midwest firms that provide health insurance found this policy caused a 2.3 percentage point (7.6%) increase in prescription contraception use (Carlin, Fertig, & Dowd, 2016). A few hundred dollars can be meaningful to lower income women, but the reduction in cost was much higher for many women.…”

“Without bodily autonomy we are not free”: exploring women’s concerns about future access to contraception following the 2016 US presidential election

“…The fearful and emotional nature of women’s worries about cost stand in stark contrast to expressions of disbelief by politicians that women have trouble affording contraception [9]. Indeed, studies have shown that cost is a significant barrier to consistent use of effective contraceptive methods [10–12]. Conversely, when cost barriers are removed, women are more likely to use prescription methods and to select highly effective methods such as IUDs and implants [10, 13], which have considerable upfront costs if paid out-of-pocket.…”