The Affordable Care Act Young Adult Provision and Pathways to Fertility

This paper investigates the effect of the Patient Protection and Affordable Care Act (ACA) young adult provision on fertility and fertility-related outcomes.  The provision expanded eligibility for young adults to obtain health insurance coverage through their parents’ plans.  This may not be an important channel for individuals who obtain their own coverage through their employers or government programs like Medicaid and Medicare.  However, many individuals are not eligible to obtain coverage through these sources.  As a result, these individuals may not have been able to afford to purchase coverage or may have purchases a suboptimal amount of coverage on their own, and obtaining any or more comprehensive coverage may affect their use of contraceptives and wantedness of pregnancies. 

It is not clear ex ante what the expected effect of the provision on fertility would be.  By expanding insurance coverage to young adults, the provision may affect fertility directly through expanded options for obtaining contraceptives, which may result in decreased fertility, as well as pregnancy- and birth-related care, which may lead to increased fertility.  In addition, the provision may also affect fertility indirectly: through marriage or labor markets, and the direction and magnitude of these effects is difficult to determine. 

To investigate the effect of the provision on fertility and fertility-related outcomes, analyses apply difference-in-differences-type methods using the 2008-2014 one-year American Community Survey and 2006-2010 and 2011-2013 National Survey of Family Growth.  The paper exploits variation by age and over time in young adults’ eligibility for coverage through parents’ plans to examine the effect of the provision on fertility and pathways to fertility.  To this end, I first examine the effect of the provision on the likelihood of an individual to have had a birth within the past year.  Next, to consider pathways to fertility, I examine the effect of the provision on the likelihood of an individual to report being pregnant or trying to get pregnant, to have had an abortion, and to use various types of contraception. 

Preliminary results suggest that the implementation of the ACA young adult provision was associated with a decrease in the likelihood of having given birth.  Considering the channels leading to the decrease in fertility, further results suggest that the implementation of the ACA young adult provision was associated with a decrease in the likelihood of having had an abortion and increases in the likelihoods of being pregnant or trying to become pregnant and of using short-term hormonal contraceptives.  These results suggest that while some individuals are more likely to pursue pregnancy as a result of the provision, others are more effectively taking action to prevent pregnancy.  This paper builds on the literature considering the determinants of individuals’ fertility decisions, the literature examining the effects of policy changes on marriage behavior and family structure, and the literature exploring the effects of the ACA young adult provision.