Since the 1990s, 29 states have mandated that insurance providers include prescription contraception in their policies’ coverage. However, there is an important nuance in states’ contraceptive mandates.  Some states adopted “supply” mandates, which are mandates that only include contraceptive supplies or drugs in their coverage, while others adopted “service” mandates, which are more expansive mandates that include both contraceptive supplies as well as the complementary medical services needed to prescribe or administer a given contraceptive prescription.  This paper seeks to understand if and to what extent these two types of contraceptive insurance mandates acted as a conduit to women receiving increased preventive health care. 

These policies may affect women’s consumption of prescription contraception, but they may also encourage women to consume more preventive health care services.  The latter is especially true in states with a service mandate.  Examples of medical services often accompanying a contraceptive prescription include pap smears, pelvic examinations, breast examinations, and tests for sexually transmitted infections or diseases.  In order to measure the change in preventive health care services following the adoption of either of these two mandates, we intend to use the Behavioral Risk Factor Surveillance System (BRFSS), which is a bi-annual cross-sectional survey with relevant data available from 1993 to 2011.  Using the BRFSS, we will exploit state-level policy variation to generate difference-in-differences estimates to determine if women in states with either type of contraceptive mandate changed their utilization of the preventive health care services described above.

Evaluating the effects of these mandates is especially important given requirements set forth in the Affordable Care Act (ACA), which like service mandates, requires insurance policies to cover both prescription contraception as well as complementary health care services, like gynecological visits, pap smears, etc.  The requirements of the ACA that concern women’s reproductive health have sparked a national conversation around how the ACA may affect women’s contraceptive consumption, but, like state-level insurance mandates, the ACA also has the potential to change women’s access to preventive health care.  We believe a policy evaluation of both types of mandates is of interest to policy makers as they continue to discuss and modify elements of the ACA.