Yes, the use of long-acting reversible contraception (IUDs and implants) increased significantly once the ACA’s zero-cost coverage rules took effect. IUDs are among the most effective contraceptives, and are not subject to user error, which is often a factor in contraceptive failure. However, their initial cost (usually $500 to $1,000) is a significant deterrent if women have to pay for them out-of-pocket.
But long-term, they are more cost-effective than most other contraceptive methods. And when the up-front cost barrier is removed – as it is under the ACA – women are much more likely to select long-term birth control. And as access to birth control, especially long-acting birth control, has improved due to the ACA, the abortion rate has fallen.
Colorado’s teen birth rate and abortion rate both dropped significantly from 2009 through 2017, mainly because of a grant that provided free or low-cost IUDs to young women who would otherwise not be able to afford them. The Colorado program was funded by an anonymous donor, prior to the ACA’s reforms. But for women who have health insurance, anonymous donors are no longer necessary.
Nearly all women with health insurance – private coverage and Medicaid – have access to highly effective, long-term contraceptives now, without a cost barrier (as noted above, the Biden administration has proposed a rule change to ensure that women whose plan issuers are exempt from providing contraceptive coverage would still have a means of accessing zero-cost contraception). The ACA’s coverage mandate has translated to an increase in the number of women relying on these methods of birth control, and a sharp reduction in out-of-pocket spending on contraception in general.