Contraception mandate saves women at least $1.4 billion

The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) contraception mandate has saved women $1.4 billion a year with respect to oral contraception alone, according to a study conducted by researchers at the University of Pennsylvania Leonard Davis Institute of Health Economics and published in Health Affairs. The study, which is the first comprehensive analysis of the mandate’s effect on out-of-pocket contraception payments, also found a significant effect on payments for intrauterine devices (IUDs), as well as smaller effects on other forms of birth control. Co-author Daniel Polsky, Ph.D., suggested, “It’s possible that by decreasing out-of-pocket expenses, more women will use contraception, or switch to a longer-term method.”


Researchers reviewed 17.6 million monthly observations from a prescription claims database from a large national insurer for 790,895 women ages 13 to 45 who were enrolled in private health insurance for at least one month from 2008 to 2013. Prior to the implementation of the mandate, contraception accounted for 30 to 44 percent of prescription health costs for the women who used them. Between June 2012 and June 2013, the average out-of-pocket expense for the birth control pill decreased by 38 percent, from $32.74 in 2012 to $20.37 in 2013; the average out-of-pocket expense for IUD insertions decreased by 68 percent, from $262.38 in 2012 to $84.30 in 2013. The authors estimate that the ACA saved an average pill user $255 per year; when that figure is extrapolated to the estimated 6.88 million privately insured women using oral contraceptives, the annual saving amounts to $1.4 billion. The research revealed decreases in less popular forms of birth control, as well. However out-of-pocket payments for the ring and the patch decreased by only 2 and 3 percent, respectively.

As of June 2013, most women in the study paid nothing for contraception. However, at that time, grandfathered plans still covered 36 percent of insured workers, including some women using contraception. In addition, the ACA does not require insurers to cover all brands of contraceptive devices.


Further research is needed. However, should the decrease in out-of-pocket expenses lead to increased usage of contraceptives, Polsky notes, “that could potentially lead to a lower overall fertility rate, and potentially increased economic opportunities for women and their families.”