Insurance Coverage Mandates for Preventive Care: The Market for Contraceptives

Laws that mandate contraceptive coverage by private health insurance plans are common at the state level, and the Affordable Care Act (ACA) also recently mandated coverage at the national level. Little empirical work has examined the potential impact of these laws on women’s contraceptive utilization. I perform both 1) a short-term analysis of the impact of the ACA's mandate using available data, and 2) an examination of 29 state-level contraception coverage mandates passed between 1999 and 2010 that could shed light upon the long-term utilization impacts of the national mandate. For these analyses, I use two datasets: the first a 50-state survey with an extensive set of individual-level covariates, and the second a proprietary claims dataset with detailed information on contraceptive utilization and out-of-pocket spending. I find suggestive evidence that the state mandates resulted in increased insurance coverage of some methods of contraceptives, but find no resulting changes in overall utilization or the type of method chosen. I find that the ACA mandate has caused large decreases in out-of-pocket spending on contraceptives, but I detect only very small changes in utilization in response, implying that demand for contraceptives among privately insured women is fairly price-insensitive. My results suggest that mandating insurance coverage of contraceptives is unlikely to result in immediate or large changes in patterns of contraceptive use in the U.S.