Impact of State and Federal Contraceptive Coverage Policies on Contraceptive Use, Costs, and Pregnancy Outcomes

Abstract This project seeks to understand how state and federal policies requiring health insurers to cover prescription contraceptives have impacted both intermediate and long-term public health outcomes. Intermediate outcomes include out-of-pocket spending on contraception and contraceptive use; long-term outcomes include pregnancy spacing and adverse pregnancy outcomes. This research is important because both federal and state-level policymaking have addressed contraceptive coverage in recent years, yet contraceptive coverage policies continue to be challenged and the lack of information about policy impact hampers efforts to address the long-term public health policy goal of reducing unintended pregnancies and their consequences. At the federal level, the Patient Protection and Affordable Care Act (ACA) required most private health plans to provide no-cost coverage for all FDA-approved contraceptive methods beginning in August 2012, a benefit already provided to publicly-insured women. Prior to the ACA, 28 states and D.C. required health plans to provide some degree of contraceptive coverage; following the ACA, 11 of those states required no-cost contraceptive coverage. Over the past 20 years, 33 states have obtained waivers to expand eligibility for family planning services under Medicaid. Finally, the ACA also allowed for Medicaid expansion, which has been implemented in 34 states and D.C. to date, thereby increasing the number of low-income women with access to no-cost contraceptive coverage. We propose studying the impact of these contraceptive coverage policies using a difference-in-differences analyses, which will examine key outcomes for populations over time by comparing those exposed and not exposed to coverage policies. We will use the MarketScan® Commercial Claims and Encounters database which includes health care utilization information on approximately 50 million privately insured individuals per year and Medicaid data to determine how the implementation of state and federal contraceptive coverage policies impact: 1) out-of-pocket spending for contraceptives; 2) use of specific contraceptive methods and method adherence; and 3) interpregnancy intervals, preterm birth, and low birthweight. This study will provide needed data to inform policymaking at the state and federal levels on the impact of contraceptive coverage policies on key public health outcomes. It expands prior research in the scope of the population studied, the range of policies studied, and the outcomes investigated. Findings will indicate the extent to which contraceptive coverage policies are an effective tool for achieving the HealthyPeople family planning goals of improving pregnancy planning and spacing, and preventing unintended pregnancy.