Table 2. Receipt of Contraception, Before Affordable Care Act Expansion (2013) vs Immediately (2014) and Longer (2016) After Expansion, by State-Level Medicaid Expansion Status.
| Characteristic | Expansion states | Nonexpansion states | Expansion vs nonexpansion status difference-in-differences estimate (95% CI) | |||||
|---|---|---|---|---|---|---|---|---|
| 2013 | 2014 | 2016 | 2013 | 2014 | 2016 | 2014 vs 2013 | 2016 vs 2013 | |
| Full population, ages 15-44 y | ||||||||
| No. of eligible women | 161 720 | 164 467 | 162 656 | 108 945 | 111 522 | 101 718 | NA | NA |
| Patients receiving moderately effective and most effective contraceptiona | NA | NA | ||||||
| No. | 38 640 | 40 603 | 40 064 | 18 457 | 21 167 | 21 089 | NA | NA |
| Adjusted %b | 23.7 | 24.4 | 24.3 | 17.9 | 19.6 | 20.4 | NA | NA |
| Adjusted % difference after vs before ACAb | 0 [Reference] | 0.64 (0.02-1.25)c | 0.53 (−0.87 to 1.92) | 0 [Reference] | 1.74 (1.27-2.21)d | 2.46 (1.52-3.41)d | −1.10 (−1.88 to −0.33)c | −1.93 (−3.63 to −0.23)c |
| Patients receiving most effective contraceptione | ||||||||
| No. | 6957 | 8706 | 9913 | 1805 | 2382 | 2774 | NA | NA |
| Adjusted %b | 4.4 | 5.3 | 6.1 | 1.8 | 2.2 | 2.4 | NA | NA |
| Adjusted % difference after vs before ACAb | 0 [Reference] | 0.95 (0.61-1.29)d | 1.76 (1.17-2.36)d | 0 [Reference] | 0.36 (0.04-0.68)c | 0.58 (0.11-1.04)c | 0.59 (0.13-1.05)c | 1.19 (0.41-1.96)c |
| Adolescents, ages 15-20 y | ||||||||
| No. of eligible women | 32 521 | 32 210 | 32 496 | 22 882 | 23 347 | 20 075 | NA | NA |
| Patients receiving moderately effective and most effective contraceptiona | ||||||||
| No. | 10 058 | 9872 | 9600 | 4056 | 4480 | 4410 | NA | NA |
| Adjusted %b | 28.9 | 28.4 | 27.8 | 21.2 | 22.4 | 24.1 | NA | NA |
| Adjusted % difference after vs before ACAb | 0 [Reference] | −0.45 (−1.39 to 0.48) | −1.11 (−2.60 to 0.37) | 0 [Reference] | 1.21 (0.39-2.02)c | 2.85 (1.33-4.37)d | −1.66 (−2.89 to −0.42)c | −3.96 (−6.07 to −1.85)d |
| Patient receiving most effective contraceptione | ||||||||
| No. | 1381 | 1665 | 2042 | 290 | 328 | 395 | NA | NA |
| Adjusted %b | 4.0 | 4.9 | 6.1 | 1.80 | 1.87 | 2.10 | NA | NA |
| Adjusted % difference after vs before ACAb | 0 [Reference] | 0.87 (0.49-1.25)d | 2.09 (1.38-2.81)d | 0 [Reference] | 0.07 (−0.27 to 0.40) | 0.30 (−0.15 to 0.76) | 0.80 (0.30-1.30)c | 1.79 (0.88-2.70)d |
Abbreviations: ACA, the Affordable Care Act; NA, not applicable.
National Quality Forum standard 2903: receipt of oral contraceptive pills, injection, patch, ring, diaphragm, incident sterilization, or a long-acting reversible contraceptive method (intrauterine device or implant).
Preexpansion, postexpansion, and difference-in-difference estimates obtained from generalized estimating equation models clustered by primary clinic, assuming an independent correlation structure. Models adjusted for age, race/ethnicity, federal poverty level, urban or rural clinic location, visit rate, new patient status, Title X visit, care from a women's health care professional, presence of a state family-planning program, and pregnancy status. Data from after ACA were collected in 2014 or 2016; data before the ACA, 2013.
P < .05.
P < .01.
National Quality Forum standard 2904: receipt of long-acting reversible contraceptive methods (intrauterine device or implant).