ACA Medicaid Expansion and Contraceptive Provision to Teens

• In Event: Reproductive Care at the Margins: Abortion, Contraception, and the Consequences of Access

Abstract

Our data comes from the universe of Medicaid claims, which is combined with our newly created comprehensive index for all contraceptive National Drug Codes during the period 2010 to 2019. Using our novel dataset, we estimate the effects of Medicaid expansion on the provision of contraceptives by age group and by type of contraceptive. We rely on variation in the timing of Medicaid expansion by state to estimate difference-in-differences models using an imputation estimator that addresses econometric issues with staggered rollout of treatment.


We find that contraceptive provision increased significantly across all age groups and contraceptive types. More notably, we find that contraceptive provision increased for teens ages 15 to 19 as a result of Medicaid expansion, with the rate of provision of any contraceptive increasing by 22.3 individuals per 1,000 women ages 15 to 19 in the population, and the rate of provision of long-acting reversible contraceptives (intra-uterine devices or implants) increasing by 3.6 individuals per 1,000. To put this result in context, the baseline rates of contraceptive provision under Medicaid for this age group in 2013 (prior to expansion) were 71.6 and 7.3, for any contraceptive and LARCs specifically, illustrating that the increase in LARCs was proportionately larger (31% for any contraceptive compared to 48% for LARCs).


Our findings may not directly translate to increases in contraceptive usage or efficacy, since they largely reflect increases in Medicaid enrollment. In other words, beneficiaries may have been using a prescription contraceptive method, and provision under Medicaid then represents a financial transfer, but not necessarily an increase in contraceptive efficacy. However, the effects on LARCs can almost certainly be interpreted as reflecting an increase in contraceptive efficacy. Since a LARC can be used for 3 to 10 years, depending on the type, it is unlikely that the increase in LARCs reflects prior users. Thus, the increase in LARC provision to teens illustrates that the ACA arguably increased contraceptive efficacy for teens, a population previously thought to be unaffected by this policy.

Author

• Savannah Lillian Ellison, Georgia Institute of Technology
  Presenting Author