Full Citation

Title: Unintended consequences of health insurance: Affordable Care Act's free contraception mandate and risky sex

Citation Type: Journal Article

Publication Year: 2019

ISBN:

ISSN: 1099-1050

DOI: 10.1002/HEC.3967

NSFID:

PMCID:

PMID: 31701617

Abstract: Health insurance is a primary driver of rising medical expenditures. Economic theory suggests that insurance induces an increase in risky behaviors, but previous empirical evidence is mixed. I use a mandate in the Affordable Care Act in which contraceptives were covered at zero cost to consumers to test for unintended effects of insurance on risky sex. Leveraging mandated zero cost-sharing for contraception and pre-policy insured rates as a measure of treatment intensity, I provide evidence that this 2012 policy reduced fertility but caused unintended consequences: a decline in condom use and a subsequent increase in sexually transmitted infections (STIs). I discuss shortcomings of controlling for nonparallel pre-trends using state-trends, and I suggest an alternative to control for pre-trends directly in the context of dose-response difference-in-differences. Finally, estimates based on the 2010 dependent coverage mandate indicate health insurance provides an overall net positive effect on insurance and STI prevention.

Url: https://onlinelibrary-wiley-com.ezp1.lib.umn.edu/doi/full/10.1002/hec.3967

User Submitted?: No

Authors: Willage, Barton

Periodical (Full): Health Economics

Issue: 1

Volume: 29

Pages: 30-45

Data Collections: IPUMS USA

Topics: Fertility and Mortality, Health

Countries: