Study: Medicaid Expansion Increased Access to Long-Term Birth Control Methods

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Medicaid expansion under the Affordable Care Act increased access to long-term birth control methods for women beneficiaries, according to a study published Thursday by JAMA Network Open.

In states that expanded Medicaid under the ACA, 6 percent of women were using long-acting reversible contraceptives -- including injections and intrauterine devices, or IUDs -- in 2016, the authors found. Long-term contraceptives are considered to be the most effective, researchers say.

In comparison, non-Medicaid expansion states, 2.4 percent of women were using these contraceptives in 2016.

As a result of the expansions, the Centers for Medicare and Medicaid Services, or CMS, reports that 71.3 million Americans had healthcare coverage through Medicaid in 2019, including 64.7 people in Medicaid and 6.7 million children in Children's Health Insurance Programs, or CHIP.

By providing more people with access to care and lower out-of-pocket costs, the Medicaid expansions have allowed beneficiaries to better manage their health, which has led to better outcomes -- including increased contraceptive use -- experts said.

"While women in non-expansion states experienced an increase in the access to moderately effective or most effective methods, they remained at overall lower levels of effective contraceptive use than women seen in expansion states," the authors wrote.

States have had the option of expanding Medicaid eligibility -- to include those with incomes at 138 percent of the federal poverty level -- under the ACA, also known as Obamacare. To date, 36 states have done so.

Several studies have assessed the Medicaid expansion's effect on healthcare access and usage.

For their research, the authors of the JAMA Network Open study, from Oregon Health and Science University, reviewed electronic health record data on 310,132 women living in Medicaid expansion states and 235,408 women from states that have not expanded program eligibility.

In addition to increased use of "most effective" contraception methods, 24.4 percent of women in expansion states were using "moderately effective" approaches -- including the vaginal ring and birth control pills -- in 2016. This was up from 23.7 percent before the ACA and higher than the 20.7 percent in non-expansion states.

In all, 6.1 percent of adolescents in expansion states reported using most effective contraception methods in 2016, up from 4 percent before the ACA and nearly three times higher than the 2.1 percent in non-expansion states.

This has perhaps contributed to recent declines in teen pregnancies nationally, researchers say.

"Unintended pregnancy disproportionately affects women with low incomes," the study authors wrote. "Our findings suggest that Medicaid expansion under the ACA improved access to the most effective contraception among a population at high risk of unintended pregnancy."

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