Extending contraceptive coverage under the Affordable Care Act saves public funds

Abstract

BACKGROUND: The Affordable Care Act (ACA) will expand health care coverage to low-income Americans. Contraception services are a mandated component of ACA plans. STUDY DESIGN: A decision-analytic model was developed to compare the costs and outcomes of the current versus the proposed plan for contraceptive coverage (Federal Poverty Level=185% vs. 399%, respectively) over 5 years. The perspective adopted was that of Oregon state insurance providers. The primary outcomes were number of pregnancies averted, health costs and quality adjusted life years (QALYs). Contraceptive failure rates, costs, projected insurance coverage, contraception use and pregnancy outcome data were obtained from the published literature. Sensitivity analyses were performed for all variables. RESULTS: Extending contraceptive coverage both saves money and improves outcomes for Oregon state insurance plan providers. The proposed policy would prevent an additional 72 pregnancies per 1000 women over 5 years. Extending coverage is cost-effective, saving an additional $489 per woman enrolled over 5 years while increasing QALYs. CONCLUSIONS: Expanding contraceptive coverage under the Affordable Health Act is cost-effective for Oregon state insurance providers.