Hostname: page-component-f554764f5-fnl2l Total loading time: 0 Render date: 2025-04-22T02:18:21.090Z Has data issue: false hasContentIssue false
  • English
  • Français

Health insurance and fertility among low-income, childless, single women: evidence from the ACA Medicaid expansions

Published online by Cambridge University Press:  22 November 2023

J. Sebastian Leguizamon Open the ORCID record for J. Sebastian Leguizamon [Opens in a new window]
J. Sebastian Leguizamon*
Affiliation:
Department of Economics, Western Kentucky University, Bowling Green, KY 42101, USA
*
Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Expansions of Medicaid family planning services have been associated with decreases in pregnancy rates. Access to a broader range of medical, non-family planning services may influence pregnancy rates as well if the increased exposure to medical services spills over to other kinds of behaviour. Using a difference-in-difference approach, I examine the impact of the Affordable Care Act (ACA) Medicaid expansions on the propensity of low-income, single women to become single mothers. Previous expansions of Medicaid family planning services allow us to also investigate the influence of access to other medical services (i.e. non-family planning). I find that although access to contraceptives is associated with a reduction in the propensity of becoming a single mother among adult, low-income women, medical services beyond access to contraceptives can provide additional impacts.

Keywords

Affordable Care ActMedicaidpregnancy

JEL classification

I13: Health Insurance, Public and Private I12: Health Behavior J13: Fertility • Family Planning • Child Care • Children • Youth
Type
Article
Information
Health Economics, Policy and Law , Volume 19 , Issue 1 , January 2024 , pp. 21 - 45
Check for updates
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Abramowitz, J (2016) Saying, ‘I don't’: the effect of the affordable care act young adult provision on marriage. Journal of Human Resources 51, 933–960.CrossRefGoogle Scholar
Abramowitz, J (2018) Planning parenthood: the Affordable Care Act young adult provision and pathways to fertility. Journal of Population Economics 31, 1097–1123.CrossRefGoogle Scholar
Abramowitz, J (2020) The effect of ACA state Medicaid expansions on medical out-of-pocket expenditures. Medical Care Research and Review 77, 19–33.CrossRefGoogle ScholarPubMed
Ananat, EO, Gruber, J and Levine, P (2007) Abortion legalization and life-cycle fertility. Journal of Human Resources 42, 375–397.CrossRefGoogle Scholar
Angrist, JD and Evans, WN (2000) Schooling and labor market consequences of the 1970 state abortion reforms. Research in Labor Economics 18, 75–113.CrossRefGoogle Scholar
Apostolova-Mihaylova, M and Yelowitz, A (2018) Health insurance, fertility, and the wantedness of pregnancies: evidence from Massachusetts. Contemporary Economic Policy 36, 59–72.CrossRefGoogle Scholar
Bailey, MJ (2006) More power to the pill: the impact of contraceptive freedom on women's life cycle labor supply. The Quarterly Journal of Economics 121, 289–320.Google Scholar
Bailey, MJ (2013) Fifty years of family planning: new evidence on the long-run effects of increasing access to contraception. Brookings Papers on Economic Activity Spring, 341–409.CrossRefGoogle Scholar
Bellerose, M, Collin, L and Daw, JR (2022) The ACA Medicaid expansion and perinatal insurance, health care use, and health outcomes: a systematic review. Health Affairs 41, 60–68.CrossRefGoogle ScholarPubMed
Benitez, JA and Seiber, EE (2018) US health care reform and rural America: results from the ACA's Medicaid expansions. The Journal of Rural Health 34, 213–222.CrossRefGoogle ScholarPubMed
Bertrand, M, Duflo, E and Mullainathan, S (2004) How much should we trust differences-in-differences estimates? The Quarterly Journal of Economics 119, 249–275.CrossRefGoogle Scholar
Buchmueller, T, Ham, JC and Shore-Sheppard, LD (2016) The Medicaid program. In Moffit, RA (ed.), Economics of Means-Tested Transfer Programs in the United States, Vol. 1. Chicago, IL: University of Chicago Press, pp. 21–136.Google Scholar
Chatterji, P and Li, Y (2016) Early effects of the 2010 Affordable Care Act Medicaid expansions on federal disability program participation, Technical Report, National Bureau of Economic Research.CrossRefGoogle Scholar
Chiappori, P-A and Oreffice, S (2008) Birth control and female empowerment: an equilibrium analysis. Journal of Political Economy 116, 113–140.CrossRefGoogle Scholar
Cotti, CD, Nesson, E and Tefft, N (2017) Impacts of the ACA Medicaid expansion on health behaviors: evidence from household panel data.CrossRefGoogle Scholar
Courtemanche, C, Marton, J, Ukert, B, Yelowitz, A and Zapata, D (2018) Early effects of the affordable care act on health care access, risky health behaviors, and self-assessed health. Southern Economic Journal 84, 660–691.CrossRefGoogle Scholar
Culwell, KR and Feinglass, J (2007) The association of health insurance with use of prescription contraceptives. Perspectives on Sexual and Reproductive Health 39, 226–230.CrossRefGoogle ScholarPubMed
DeLeire, T, Lopoo, LM and Simon, KI (2011) Medicaid expansions and fertility in the United States. Demography 48, 725–747.CrossRefGoogle ScholarPubMed
Dennis, A, Córdova, D, Blanchard, K, Wahlin, B, Clark, J, McIntosh, J, Edlund, K and Tsikitas, L (2009) Low-income women's access to contraception after Massachusetts health care reform. IBIS Reproductive Health and MDPH Family Planning Program. Report.Google Scholar
Dennis, A, Clark, J, Córdova, D, McIntosh, J, Edlund, K, Wahlin, B, Tsikitas, L and Blanchard, K (2012) Access to contraception after health care reform in Massachusetts: a mixed-methods study investigating benefits and barriers. Contraception 85, 166–172.CrossRefGoogle ScholarPubMed
Eliason, EL, Daw, JR and Allen, HL (2022 a) Association of Affordable Care Act Medicaid expansions with births among low-income women of reproductive age. Journal of Women's Health 31, 949–956.CrossRefGoogle ScholarPubMed
Eliason, EL, Spishak-Thomas, A and Steenland, MW (2022 b) Association of the affordable care act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy. Contraception 113, 42–48.CrossRefGoogle ScholarPubMed
Finer, LB and Henshaw, SK (2006) Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspectives on Sexual and Reproductive Health 38, 90–96.CrossRefGoogle ScholarPubMed
Frean, M, Gruber, J and Sommers, BD (2017) Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act. Journal of Health Economics 53, 72–86.CrossRefGoogle ScholarPubMed
Frost, JJ and Lindberg, LD (2013) Reasons for using contraception: perspectives of US women seeking care at specialized family planning clinics. Contraception 87, 465–472.CrossRefGoogle ScholarPubMed
Gartner, DR, Kaestner, R and Margerison, CE (2022) Impacts of the Affordable Care Act's Medicaid expansion on live births. Epidemiology 33, 406.CrossRefGoogle ScholarPubMed
Geiger, CK, Sommers, BD, Hawkins, SS and Cohen, JL (2021) Medicaid expansions, preconception insurance, and unintended pregnancy among new parents. Health Services Research 56, 691–701.CrossRefGoogle ScholarPubMed
Gold, RB (2009) Family planning centers meet health care reform: lessons from Massachusetts. Guttmacher Policy Review 12, 2–10.Google Scholar
Goldin, C and Katz, LF (2000) Career and marriage in the age of the pill. American Economic Review 90, 461–465.CrossRefGoogle ScholarPubMed
Goldin, C and Katz, LF (2002) The power of the pill: oral contraceptives and women's career and marriage decisions. Journal of political Economy 110, 730–770.CrossRefGoogle Scholar
Goodman-Bacon, A (2021) Difference-in-differences with variation in treatment timing. Journal of Econometrics 225, 254–277.CrossRefGoogle Scholar
Gross, T, Lafortune, J and Low, C (2014) What happens the morning after? The costs and benefits of expanding access to emergency contraception. Journal of Policy Analysis and Management 33, 70–93.CrossRefGoogle ScholarPubMed
Heim, B, Lurie, I and Simon, K (2018) The impact of the Affordable Care Act young adult provision on childbearing: evidence from tax data. Demography 55, 1233–1243.CrossRefGoogle ScholarPubMed
Johnston, EM, Strahan, AE, Joski, P, Dunlop, AL and Adams, EK (2018) Impacts of the Affordable Care Act's Medicaid expansion on women of reproductive age: differences by parental status and state policies. Women's Health Issues 28, 122–129.CrossRefGoogle ScholarPubMed
Joyce, T and Kaestner, R (1996) The effect of expansions in Medicaid income eligibility on abortion. Demography 33, 181–192.CrossRefGoogle ScholarPubMed
Joyce, T, Kaestner, R and Kwan, F (1998) Is Medicaid pronatalist? The effect of eligibility expansions on abortions and births. Family Planning Perspectives May, 108–127.CrossRefGoogle Scholar
Kaestner, R, Garrett, B, Chen, J, Gangopadhyaya, A and Fleming, C (2017) Effects of ACA Medicaid expansions on health insurance coverage and labor supply. Journal of Policy Analysis and Management 36, 608–642.CrossRefGoogle ScholarPubMed
Kearney, MS and Levine, PB (2009) Subsidized contraception, fertility, and sexual behavior. The Review of Economics and Statistics 91, 137–151.CrossRefGoogle ScholarPubMed
Kilmer, G, Leon-Nguyen, M, Smith-Grant, J, Brittain, AW, Rico, A, Adkins, SH, Lim, C and Szucs, LE (2022) Medicaid expansion and contraceptive use among female high-school students. American Journal of Preventive Medicine 63, 592–602.CrossRefGoogle ScholarPubMed
Klerman, JA (1999) US abortion policy and fertility. American Economic Review 89, 261–264.CrossRefGoogle ScholarPubMed
Kominski, GF, Nonzee, NJ and Sorensen, A (2017) The Affordable Care Act's impacts on access to insurance and health care for low-income populations. Annual Review of Public Health 38, 489–505.CrossRefGoogle ScholarPubMed
Levine, PB, Staiger, D, Kane, TJ and Zimmerman, DJ (1999) Roe v Wade and American fertility. American Journal of Public Health 89, 199–203.CrossRefGoogle Scholar
Lindrooth, RC and McCullough, JS (2007) The effect of Medicaid family planning expansions on unplanned births. Women's Health Issues 17, 66–74.CrossRefGoogle ScholarPubMed
McMorrow, S, Kenney, GM, Long, SK and Gates, J (2017) The ACA Medicaid expansion led to widespread reductions in uninsurance among poor, childless adults, Washington, DC: Urban Institute.Google Scholar
Mellor, JM (1998) The effect of family planning programs on the fertility of welfare recipients: evidence from Medicaid claims. Journal of Human Resources 33, 866–895.CrossRefGoogle Scholar
Michael, R (2000) Abortion Decisions in the U.S. Chicago, IL: The University of Chicago Press.Google Scholar
Miller, JA, Graefe, DR and De Jong, GF (2013) Health insurance coverage predicts lower childbearing among near-poor adolescents. Journal of Adolescent Health 53, 749–755.CrossRefGoogle ScholarPubMed
Mulligan, K (2015) Contraception use, abortions, and births: the effect of insurance mandates. Demography 52, 1195–1217.CrossRefGoogle ScholarPubMed
Myerson, R, Crawford, S and Wherry, LR (2020) Medicaid expansion increased preconception health counseling, folic acid intake, and postpartum contraception. Health Affairs 39, 1883–1890.CrossRefGoogle ScholarPubMed
NCHS (2005) Fertility, family planning, and reproductive health of U.S. women: data from the 2002 National Survey of Family Growth, Vital and Health Statistics Series 23 5, National Center for Health Statistics, Hyattsville, MD.Google Scholar
Palmer, M (2020) Does publicly subsidized health insurance affect the birth rate? Southern Economic Journal 87, 70–121.CrossRefGoogle Scholar
Peipert, JF, Madden, T, Allsworth, JE and Secura, GM (2012) Preventing unintended pregnancies by providing no-cost contraception. Obstetrics and Gynecology 120, 1291.CrossRefGoogle ScholarPubMed
Ranji, U, Bair, Y and Salganicof, A (2016) Medicaid and family planning: background and implications of the ACA, Women's Health Policy Brief, Kaiser Family Foundation February.Google Scholar
Simon, K, Soni, A and Cawley, J (2017) The impact of health insurance on preventive care and health behaviors: evidence from the first two years of the ACA Medicaid expansions. Journal of Policy Analysis and Management 36, 390–417.CrossRefGoogle ScholarPubMed
Sommers, BD, Gawande, AA and Baicker, K (2017) Health insurance coverage and health – what the recent evidence tells us.CrossRefGoogle Scholar
Sonfield, A and Gold, RB (2011) Medicaid family planning expansions: lessons learned and implications for the future, Citeseer.Google Scholar
Vlahiotis, A, Tian, Y and Iyengar, R (2015) Impact of the patient protection and Affordable Care Act contraceptive coverage mandate on utilization of refillable and long-acting reversible contraceptives. Value in Health 18, A113.CrossRefGoogle Scholar
Zavodny, M and Bitler, MP (2010) The effect of Medicaid eligibility expansions on fertility. Social Science & Medicine 71, 918–924.CrossRefGoogle ScholarPubMed