How Publicly Subsidized Health Insurance Affects the Birth Rate

Abstract

The Affordable Care Act greatly expanded subsidized health insurance opportunities for low-income childless women through Medicaid and the Marketplace. This insurance provides better access to prescription-based contraception, which could reduce the number of births. At the same time, it lowers childbirth costs for women who previously would not have qualified for Medicaid-paid pregnancies. I examine how Medicaid and non-Medicaid subsidized insurance (NMSI) eligibility have impacted insurance enrollment and the birth rate for childless women from 2011 through 2016 using the American Community Survey and birth information from the Vital Statistics. To estimate the causal effects of subsidized insurance, I use simulated eligibility to utilize variation in the timing and income eligibility thresholds for Medicaid, the Marketplace, and other pre-ACA state subsidized insurance programs. My results indicate expanding Medicaid had no significant effect on the birth rate, but that a 10 percentage point increase in NMSI eligibility increased the birth rate between 1.60% and 2.30%, depending on the age group. These findings indicate that expanding Medicaid to childless adults did not produce cost savings from fewer Medicaid paid births, but improvements in the non-group insurance market increased births.