Nora V. Becker (
Nancy L. Keating is a professor of health care policy and medicine in the Department of Health Care Policy, Harvard Medical School, and the Division of General Internal Medicine, Brigham and Women's Hospital, both in Boston, Massachusetts.
Health Aff (Millwood). 2021 Apr;40(4):579-586. doi: 10.1377/hlthaff.2020.01710.
The Affordable Care Act (ACA) mandated that private health plans cover contraceptives without out-of-pocket expenses for patients. Previously, long-acting reversible contraceptives (LARCs) were subject to deductibles, making them a higher-cost service for women with high-deductible health plans (HDHPs); however, the ACA mandate applied to HDHPs as well as traditional health plans. Using a national commercial claims database, we examined LARC use among continuously enrolled reproductive-age women between 2010 and 2017, comparing 9,014 women enrolled in HDHPs with 443,363 women enrolled in non-HDHPs. Using a quasi-experimental difference-in-differences analysis, we found that pre-ACA HDHP enrollees had lower LARC initiation rates than women in non-HDHPs and that rates of LARC initiation increased by 35 percent more postmandate for women in HDHPs than for women in traditional plans. These findings suggest that the ACA had a particularly important impact for women in HDHPs, who faced higher pre-ACA out-of-pocket expenses for these contraceptive methods.
平价医疗法案（ACA）要求私人医疗保险计划为患者提供无自付费用的避孕措施。此前，长效可逆避孕措施（LARC）受免赔额限制，对于高免赔额健康计划（HDHPs）的女性来说，这是一项成本更高的服务；然而，ACA 的规定也适用于 HDHPs 和传统健康计划。我们使用全国商业索赔数据库，调查了 2010 年至 2017 年间连续参保育龄妇女的 LARC 使用情况，比较了 9014 名参加 HDHPs 的妇女和 443363 名参加非 HDHPs 的妇女。通过拟实验差分法分析，我们发现，ACA 实施前，HDHP 参保者的 LARC 起始率低于非 HDHP 参保者，而在 ACA 实施后，HDHP 参保者的 LARC 起始率比传统计划参保者增加了 35%。这些发现表明，ACA 对 HDHP 参保者产生了特别重要的影响，因为她们在 ACA 实施前需要为这些避孕方法支付更高的自付费用。
