Early Impact of the Affordable Care Act on Uptake of Long-acting Reversible Contraceptive Methods

Abstract

Background The Affordable Care Act (ACA) required most private insurance plans to cover contraceptive services without patient cost-sharing as of January 2013 for most plans. Whether the ACA’s mandate has impacted long-acting reversible contraceptives (LARC) use is unknown. Objective The aim of this article is to assess trends in LARC cost-sharing and uptake before and one year after implementation of the ACA’s contraceptive mandate. Design Retrospective cohort study using Truven Health MarketScan claims data from January 2010–December 2013. Subjects Women aged 18–45 with continuous insurance coverage with claims for oral contraceptive pills, patches, rings, injections, or LARC during 2010–2013 (N=3,794,793). Measures Descriptive statistics were used to assess trends in LARC cost-sharing and uptake from 2010 through 2013. Interrupted time series models were used to assess the association of time, ACA, and time following the ACA on LARC cost-sharing and initiation rates, adjusting for patient and plan characteristics. Results The proportion of claims with $0 cost-sharing for IUDs and implants, respectively, rose from 36.6% and 9.3% in 2010, to 87.6% and 80.5% in 2013. The ACA was associated with a significant increase in these proportions and in their rate of increase (level and slope change both P<.001). LARC uptake increased over time with no significant change in level of LARC use post-ACA implementation in January 2013 (P=0.44) and a slightly slower rate of growth post-ACA than previously (beta coefficient for trend: −0.004, p<0.001). Conclusions The ACA has significantly decreased LARC cost-sharing, but during its first year had not yet increased LARC initiation rates.

Association of Access to Family Planning Services With Medicaid Expansion Among Female Enrollees in Michigan

“…Although improved contraceptive access is a critical first step in improving contraceptive use and reducing unintended pregnancy rates, prior studies of the effects of expanded coverage on access to contraceptive services and reproductive health outcomes 26 , 27 , 28 , 29 , 30 , 31 , 32 have had mixed results. Multiple studies 26 , 27 , 28 , 29 suggest that Medicaid family planning waivers and state plan amendments to expand family planning coverage to women not otherwise eligible for Medicaid have been associated with increased contraceptive use and significant reductions in unintended pregnancy rates.…”

Public perception of the United States’ Affordable Care Act

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Advancing Sex- and Gender-Informed Approaches to Health in an Academic Medical Center

“…This summit and accompanying report (Johnson, Fitzgerald, Salganicoff, Wood, & Goldstein, 2014) contributed to subsequent National Institutes of Health requirements to consider sex as a key variable in research studies. The WHPAP also conducts policy research to examine the impact of state and federal health policies on gender-specific care delivery and outcomes, for example, the use of preventive care in low-income Massachusetts women after state-level payment reform (Clark et al, 2014) and contraceptive use after the Affordable Care Act eliminated cost sharing (Pace, Dusetzina, & Keating, 2016a, 2016b. All of these activities are facilitated by the Connors Center's multidisciplinary perspective, which we feel is critical in promoting scientifically sound and equitable health policies.…”