J Policy Anal Manage. 2018;37(3):571-601.
The Affordable Care Act (ACA) mandates that prescription contraceptives be covered by private health insurance plans with no cost sharing. Using medical and prescription claims from a large national insurer, I estimate individual claim rates and out-of-pocket (OOP) costs of prescription contraceptives for 329,642 women aged 13 to 45 who were enrolled in private health insurance between January 2008 and December 2013. I find that OOP spending on contraceptives has decreased sharply since the implementation of the ACA mandate. Using a difference-in-difference model that leverages employer level variation in compliance with the mandate, I estimate the effect of the mandate on use of both short- and long-term methods of prescription birth control. I find that the mandate has increased insurance claims for short-term contraceptive methods (the pill, patch, ring, shot, diaphragms/cervical caps, and prescription emergency contraception) by 4.8 percent and increased initiation of long-term methods (intrauterine devices, implant, or sterilization) by 15.8 percent. Using data from a national survey of reproductive age women during this same time period, a back-of-the-envelope calculation suggests that the mandate increased total use of any method of prescription contraceptive use by 2.95 percentage points among privately insured women in 2013, or a 6.57 percent relative increase. These increases in use of prescription contraceptives among privately insured women in the United States as a result of the ACA mandate have important potential implications for fertility rates, health care spending, and economic outcomes for women and their families.
平价医疗法案（ACA）要求私人医疗保险计划免费提供处方避孕药具。我利用一家大型全国保险公司的医疗和处方索赔数据，估算了 2008 年 1 月至 2013 年 12 月期间 329642 名年龄在 13 至 45 岁之间参加私人医疗保险的女性的个人索赔率和处方避孕药具的自付费用（OOP）。我发现，自 ACA 授权实施以来，避孕药具的 OOP 支出大幅下降。我利用雇主遵守授权规定的差异来利用差异中的差异模型，估算了该授权对短期和长期处方生育控制方法使用的影响。我发现，该授权增加了短期避孕药具方法（避孕药、贴片、环、注射、隔膜/宫颈帽和处方紧急避孕药）的保险索赔 4.8%，并增加了长期方法（宫内节育器、植入物或绝育）的启动率 15.8%。利用同期全国育龄妇女调查数据进行的简单计算表明，2013 年，该授权使私人保险女性中任何处方避孕药具的总使用率增加了 2.95 个百分点，即相对增加了 6.57%。由于 ACA 授权，美国私人保险女性中处方避孕药具使用量的增加对生育率、医疗保健支出以及妇女及其家庭的经济结果具有重要的潜在影响。
