, Volume 55, Issue 4, pp 1233–1243 | Cite as

The Impact of the Affordable Care Act Young Adult Provision on Childbearing: Evidence From Tax Data

  • Bradley Heim
  • Ithai Lurie
  • Kosali SimonEmail author


We use panel U.S. tax data spanning 2008–2013 to study the impact of the Affordable Care Act (ACA) young adult provision on an important demographic outcome: childbearing. The impact is theoretically ambiguous: gaining insurance may increase access to contraceptive services while also reducing the out-of-pocket costs of childbirth. Because employer-reported U.S. Wage and Tax Statements (W-2 forms) record access to employer-provided benefits, we can examine the impact of the coverage expansion by focusing on young adults whose parents have access to benefits. We compare those who are slightly younger than the age threshold with those who are slightly older. Our results suggest that the ACA young adult provision led to a modest decrease in childbearing.


Health insurance Childbearing Affordable Care Act 



The views expressed are those of the authors and are not necessarily those of the U.S. Department of the Treasury (USDT). We thank Angshuman Gooptu and Kate Yang for research assistance.


  1. Abramowitz, J. (2016). Saying “I don’t”: The effect of the Affordable Care Act young adult provision on marriage. Journal of Human Resources, 51, 933–960.CrossRefGoogle Scholar
  2. Abramowitz, J. (2017). Planning parenthood: The Affordable Care Act young adult provision and pathways to fertility. Journal of Population Economics. Advance online publication.
  3. Akosa Antwi, Y., Moriya, A. S., & Simon, K. (2013). Effects of federal policy to insure young adults: Evidence from the 2010 Affordable Care Act dependent coverage mandate. American Economic Journal: Economic Policy, 5(4), 1–28.Google Scholar
  4. Barbaresco, S., Courtemanche, C. J., & Qi, Y. (2015). Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults. Journal of Health Economics, 40, 54–68.CrossRefGoogle Scholar
  5. Braveman, P., Bennett, T., Lewis, C., Egerter, S., & Showstack, J. (1993). Access to prenatal care following major Medicaid eligibility expansions. JAMA, 269, 1285–1289.CrossRefGoogle Scholar
  6. Culwell, K. R., & Feinglass, J. (2007). The association of health insurance with use of prescription contraceptives. Perspectives on Sexual and Reproductive Health, 39, 226–230.CrossRefGoogle Scholar
  7. Currie, J., & Gruber, J. (1997). The technology of birth: Health insurance, medical interventions, and infant health (NBER Working Paper No. 5985). Cambridge, MA: National Bureau of Economic Research.Google Scholar
  8. DeLeire, T., Lopoo, L. M., & Simon, K. I. (2011). Medicaid expansions and fertility in the United States. Demography, 48, 725–747.CrossRefGoogle Scholar
  9. Egerter, S., Braveman, P., & Marchi, K. (2002). Timing of insurance coverage and use of prenatal care among low-income women. American Journal of Public Health, 92, 423–427.CrossRefGoogle Scholar
  10. Kaestner, R. (1999). Health insurance, the quantity and quality of prenatal care, and infant health. Inquiry, 36, 162–175.Google Scholar
  11. Ma, J. (2015). Health insurance and fertility decisions: Evidence from Affordable Care Act young adult provision. Unpublished manuscript, Department of Economics, Indiana University–Bloomington, Bloomington, IN.Google Scholar
  12. Miller, J. A., Graefe, D. R., & De Jong, G. F. (2013). Health insurance coverage predicts lower childbearing among near-poor adolescents. Journal of Adolescent Health, 53, 749–755.Google Scholar
  13. Oberg, C. N., Lia-Hoagberg, B., Skovholt, C., Hodkinson, E., & Vanman, R. (1991). Prenatal care use and health insurance status. Journal of Health Care for the Poor and Underserved, 2, 270–291.CrossRefGoogle Scholar
  14. Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The Affordable Care Act has led to significant gains in health insurance and access to care for young adults. Health Affairs, 32, 165–174.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2018

Authors and Affiliations

  1. 1.School of Public and Environmental AffairsIndiana UniversityBloomingtonUSA
  2. 2.Office of Tax Analysis, U.S. Department of the TreasuryWashingtonUSA
  3. 3.National Bureau of Economic ResearchCambridgeUSA

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