Association for Public Policy Analysis & Management

A growing body of literature has investigated the recent decline in teen pregnancy in the United States. While no definitive causes have been identified, implementation of the Children’s Health Insurance Program (CHIP) in 1997 may be one factor in explaining this trend. For many adolescents, CHIP represents their first exposure to a public health insurance program. By increasing access to care for adolescents, CHIP expansions have the potential to increase teenage contraception use and, in turn, decrease teenage fertility. Importantly, CHIP expansions are predicted to increase the use of contraceptive methods requiring a prescription or specialized procedure, but not the use of over-the-counter methods, such as condoms. These methods requiring a prescription or procedure are also more effective than over-the-counter methods at preventing pregnancy. Despite the serious consequences of teen childbearing and the plausible role of public health insurance in increasing adolescents access to contraception, to the best of our knowledge there are no national-level studies that investigate the impact of CHIP expansions on adolescent birth rates or contraception use.

We use pooled Youth Risk Behavior Surveillance System (YRBSS) data (1991-2005) and variation in state income eligibility thresholds for CHIP by year and age (1990-2004) to test the effects of CHIP income eligibility thresholds on the likelihood of adolescent sexual activity and contraceptive use. We conduct all analyses using difference-in-differences models, which exploit variation in public insurance eligibility at the state, year, and age level. We find that a 100 percentage point increase in the CHIP income eligibility limit increased the likelihood of contraception use among sexually active adolescents by 1.4 percentage points. This result translates into am 11 percent increase in contraception use among sexually active teens, relative to a baseline mean of 13 percent. Larger effects were found for females, Hispanics, and older adolescents. We find no effects of CHIP eligibility levels on adolescents’ sexual activity or condom use.

Our results indicate that the implementation of the CHIP program and the resulting expansions in public insurance eligibility for adolescents was modestly successful at increasing contraception use among sexually active teens. Combined with no observed impact on sexual activity or condom use among teens, this finding suggests that CHIP expansion may have contributed toward the long-term decline in teen birth rates during this period by increasing teens’ use of prescription contraceptives.