Health Insurance and Fertility Decisions: Evidence from Affordable Care Act Young Adult Provision

This study provides evidence of the impact of health insurance on fertility decisions in the context of young adults. The Affordable Care Act young adult provision has been shown to expand private health insurance coverage for the intended age group. Having health insurance improves access to family planning services and could reduce unintended pregnancy. The provision may also improve health insurance access during pregnancy and encourage child births. Using birth certificate data and a differencein-differences study design, we examined the impact of the provision on fertility rates, prenatal care and birth outcomes by comparing the targeted group to slightly older adults. We found that the young adult provision reduced fertility rates by about 5% in the first 3 years following the policy change and increased the share of children born to unmarried, minority, or less educated mothers. The evidence also suggests that the provision encouraged earlier initiation of prenatal care and reduced maternal smoking and pregnancy complications. However, birth weight and gestational age seems to be non-responsive to the provision.