The Effect of the ACA Dependent Coverage Provision on Sexual and Reproductive Health Services Utilization Among Young Adult Women

Background and Purpose:

The dependent coverage provision of the Affordable Care Act (ACA) expanded insurance access for young adults by allowing this group to maintain health insurance coverage through a parent’s plan until the age of 26. Studies have indicated an increase in healthcare coverage and utilization among young adults following this provision, with potentially differential gains in health insurance coverage by race. This study examines whether the dependent coverage provision of the ACA was associated with a change in the utilization of preventive sexual and reproductive health services among young adult women, and if there were distinctive effects by race/ethnicity.

Methods:

We use National Survey of Family Growth data to examine sexual and reproductive health services utilization among young adult women before (2008-2009) and after (2011-2013) enactment of the ACA dependent coverage provision. We use a difference-in-differences model to evaluate the association between the dependent coverage provision and six measures of preventive sexual and reproductive health services, treating women 23 to 25 years old who are eligible for dependent coverage as the exposure group and women 27 to 28 years old who are ineligible for the provision as the control group.

Results:

The dependent coverage provision was associated with a significant increase in the probability of having received a pelvic exam in the last 12 months (p=0.028). We observed no significant effects of the dependent coverage provision on utilization in the last 12 months for birth control method or prescription, birth control counseling, a check-up or medical test related to birth control, pap smear tests, or testing/treatment/counseling for STDs. In stratified difference-in-difference models by race/ethnicity, the effect on pelvic exams is most concentrated among black women. No significant effects are seen among white women. Increases in check-ups or medical tests related to using a birth control method are present only for Hispanic women (p=0.008).

Conclusions:

The dependent coverage provision of the ACA was significantly associated with an increase in pelvic exams, primarily concentrated among non-Hispanic black women. In stratified analyses, Hispanic women were seen to have an increase in check-ups or medical tests related to using a birth control method after the dependent coverage expansion. This ACA provision did not appear to increase birth control utilization or counseling, STD service utilization, or pap smear tests.

Implications:

These findings could imply that young women’s consumption of preventative sexual and reproductive services may not be contingent on insurance access. The differential effect of the dependent coverage provision on young women by race/ethnicity could indicate differences in pre-policy access or needs. It is possible that groups benefit differentially from the availability of sexual health centers and clinics, leaving differences in needs among young adult women by race/ethnicity. Despite the increased utilization of some services, use of preventive sexual and reproductive health services remains lower for black and Hispanic young adult women. These findings imply that more targeted outreach efforts would be necessary to increase care utilization for black and Hispanic young adult women and insurance expansions alone are insufficient.