New Kaiser Permanente study shows impact of elimination of cost-sharing for contraception on women’s health
More women began using contraception and rates of unintended pregnancy and abortion declined after health insurers were required to provide contraception for women at no cost under the Affordable Care Act, a new Kaiser Permanente study found.
The research was published October 31 in Obstetrics & Gynecology.
“Examining the impact of health care policies on patient outcomes is essential,” said lead author Matthew D. Solomon, MD, PhD, a physician-scientist at the Kaiser Permanente Northern California Division of Research and a cardiologist with The Permanente Medical Group. “Our study demonstrates that removing cost-sharing for contraception — a key element of the Affordable Care Act — not only improved access to contraception but also led to a reduction in unintended pregnancies. This is one example of how the ACA has enhanced public health. If reducing unintended pregnancies is a public health goal, ensuring broad access to contraception is essential.”
The Affordable Care Act was signed into law in 2010. The mandate that all private health insurance plans cover the full range of contraception approved by the U.S. Food & Drug Administration with no cost-sharing or co-pays went into effect in August 2012. Insurers had to implement the policy by January 2013.
The study included 1,523,962 women ages 18 to 45 who were members of Kaiser Permanente Northern California (KPNC) from January 2007 to December 2018. The researchers looked at changes in contraception use and rates of pregnancy and abortion over this 11-year period.
The average annual out-of-pocket costs for women using contraception dropped from a range of $88 to $94 before 2013 to nearly zero after the mandate went into place, the study found.
The percentage of women prescribed contraception increased from 30% in 2007 to 32% by December 2018. The researchers identified a change in contraception preferences, finding an increase in the percentage of women who opted for long-acting reversible contraception, such as intrauterine devices (IUDs) and contraceptive implants, after cost-sharing was eliminated.
The study also found that pregnancy rates declined more dramatically after cost-sharing was eliminated. The researchers said this was likely due to the increased use of contraception.
Abortion rates began to decline before the ACA went into place, and they continued to decline after cost-sharing for contraception was eliminated.
“Unintended pregnancies can have an emotional, social, and/or economic impact on many women,” said study co-author Eve Zaritsky, MD, an obstetrician-gynecologist, minimally invasive gynecologic surgeon, and researcher with The Permanente Medical Group. “By eliminating cost sharing, the ACA improved access for women to contraception, and that has had a huge impact on their reproductive and overall health.”
Reducing unintended pregnancies has been a public health objective for decades, and the researchers said their study shows that improved access to contraception moves public health closer to that goal.
“This project is an exciting example of the kind of study that we’re uniquely able to do at the Division of Research because of the large and diverse group of patients we see,” said senior author Mary Reed, DrPH, a research scientist with the Division of Research. “We were able to use our data to examine the effect of changes in health care coverage implemented through the ACA and this can inform future decisions about how health care is provided in this country.”
The study was supported by Kaiser Permanente Northern California Community Health and Kaiser Permanente Northern California Graduate Medical Education.
Co-authors include Margaret Warton, MPH, and Andrea Millman, MA, of the Division of Research; and Ashley Huynh, BS, and Bharathi Chinnakotla, BA, MPH, who participated in the Kaiser Permanente SCORE program.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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