OBJECTIVE To investigate the effects of the Affordable Care Act (ACA) and its elimination of cost-sharing on contraception utilization, pregnancy rates, and abortion rates. METHODS We conducted a retrospective cohort study within a healthcare system serving over 4.5 million insured members across 21 medical centers and 250 clinics. The study included women aged 18-45 with continuous health plan membership for at least two years in the pre-ACA (2007-2012) and post-ACA (2013-2018) periods. We analyzed out-of-pocket (OOP) costs for contraception, including oral contraceptives and long-acting reversible contraception (LARC), before and after the ACA's implementation. We then examined how the elimination of OOP costs affected contraception use, pregnancy rates, and abortion rates. RESULTS The study identified 1,523,962 women of childbearing age. In 2013, cost sharing for contraception sharply declined, with average annual OOP costs dropping from $88-$94 pre-ACA to nearly zero post-ACA. Contraceptive use increased overall, rising from 30.2% pre-ACA to 31.9% by the study's end, with a notable rise in LARC use. In interrupted time-series analyses, while contraception use continued to increase post-ACA, new pregnancy rates declined at a faster rate than pre-ACA, and abortion rates continued to fall, though at a slightly slower pace than pre-ACA (p<0.05 for all trends). CONCLUSIONS The Affordable Care Act's elimination of contraception cost-sharing led to increased contraception use, particularly LARC methods, and contributed to declines in both pregnancy and abortion rates. This suggests that improving access to effective contraception is a key strategy in reducing unintended pregnancies.

中文翻译：

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平价医疗法案对避孕、怀孕和妊娠终止率的影响。


目的 调查平价医疗法案 （ACA） 及其取消成本分摊对避孕措施利用率、怀孕率和流产率的影响。方法 我们在一个医疗保健系统内进行了一项回顾性队列研究，该系统为 21 个医疗中心和 250 个诊所的 450 多万名投保成员提供服务。该研究包括 18-45 岁的女性，她们在 ACA 之前 （2007-2012） 和 ACA 后 （2013-2018） 期间连续成为健康计划成员至少两年。我们分析了 ACA 实施前后的避孕自付费用 （OOP），包括口服避孕药和长效可逆避孕药 （LARC）。然后，我们研究了消除 OOP 成本如何影响避孕措施的使用、怀孕率和流产率。结果 该研究确定了 1,523,962 名育龄妇女。2013 年，避孕成本分摊急剧下降，平均年平均 OOP 成本从 ACA 之前的 88-94 美元下降到 ACA 后的几乎为零。避孕药具的使用总体上有所增加，从 ACA 之前的 30.2% 上升到研究结束时的 31.9%，LARC 的使用显着增加。在中断的时间序列分析中，虽然 ACA 后避孕措施的使用继续增加，但新妊娠率下降的速度比 ACA 前快，流产率继续下降，尽管速度略慢于 ACA 前（所有趋势的 p<0.05）。结论 《平价医疗法案》取消了避孕费用分摊，导致避孕药具的使用增加，尤其是 LARC 方法，并导致怀孕率和流产率下降。这表明，改善获得有效避孕措施的机会是减少意外怀孕的关键策略。