National Partnership for Women & Families

Monthly Women's Health Research Review

Study: Removing employer-sponsored contraceptive coverage linked to increased pregnancy rates, higher costs

Summary of "Implications of employer coverage of contraception: Cost-effectiveness analysis of contraception coverage under an employer mandate," William Canestaro et al., Contraception, August 16, 2016.

In this study, William Canestaro of the University of Washington's School of Pharmacy and colleagues aimed to estimate the impact of "private, employer-sponsored insurance coverage" under the Affordable Care Act (ACA) "on pregnancies, pregnancy outcomes and costs."

The researchers developed a decision model from the perspective of the employer "to simulate costs and outcomes associated with employer-sponsored coverage of contraception methods" under the ACA. According to the researchers, the model simulated "a cohort of 1 million women either offered 1) full contraceptive coverage through an employer-sponsored private health insurance plan or 2) no coverage to estimate the effect of complete contraceptive coverage on US women of [reproductive] age."


The researchers found that "for one million women with the same age distribution as the US population, removing insurance coverage for contraceptives results in approximately 33,203 ... additional unintended pregnancies," and 13,460 additional abortions. According to the researchers, "insurance coverage was significantly associated with women's choice of contraception method, with the use of oral contraceptives significantly lower in the uninsured group."

The researchers projected that "employers choosing not to offer contraception coverage to their employees will experience significantly higher expenditures...even when excluding insurance costs associated with abortions." Specifically, the researchers found that depending on employers' coverage policies, removing contraceptive coverage "resulted in a statistically significant increase" of $251, 929,900 per one million women, $149,931,300 per one million women or $139,676,500 per one million women.

According to the researchers, "The effect of no insurance was greatest on unmarried women 20-29 years old," with an additional 25,228 abortions for every one million women ages 20-24 lacking contraceptive coverage and an additional 28,054 abortions for every one million women ages 25-29 lacking contraceptive coverage.


"Our model shows that removing private health insurance coverage for contraceptive methods results in more unintended pregnancies, more...abortions, and greater total costs from the societal and employer perspectives," regardless of whether abortions were covered under the insurance plan, the researchers wrote. They added that the repercussions of removing contraceptive coverage could have a disparate effect on low-income women, "play[ing] a significant role in reinforcing the cycle of poverty and economic stagnation that often accompanies unintended pregnancy."

According to the researchers, the study's results "are particularly compelling given the recent political discourse related to private insurance coverage and employer-sponsored coverage of contraceptives in the U.S. market." They explained that while it is not yet known how many employers and insurers will seek an exemption from providing contraceptive coverage under the Supreme Court's ruling in Hobby Lobby, the study "suggests that the lack of insurance coverage that might result from exemptions could present a significant public health problem if other avenues for affordable access to contraceptives are not made available."

Conversely, the researchers wrote that the study shows "the increased utilization achieved by making contraception available through employer-based insurance plans at no cost-sharing" for women of reproductive age "may be a highly successful strategy in reducing" unintended pregnancies and associated costs. They concluded, "Employers and health plans that are deciding whether or not to offer [contraceptive] coverage at no cost-sharing to their employees should consider the full impact that this decision could have on their bottom line, on the physical and economic health of their employees, and on public health outcomes."