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

Health Econ Policy Law. 2024 Jan;19(1):21-45. doi: 10.1017/S1744133123000282. Epub 2023 Nov 22.

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 Act; Medicaid; pregnancy.

MeSH terms

  • Adult
  • Contraceptive Agents
  • Female
  • Fertility
  • Health Services Accessibility
  • Humans
  • Insurance Coverage
  • Insurance, Health
  • Medicaid*
  • Patient Protection and Affordable Care Act*
  • United States

Substances

  • Contraceptive Agents