t This paper investigates the effect of the Affordable Care Act young adult
provision on fertility and related outcomes. The expected effect of the provision on
fertility is not clear ex ante. By expanding insurance coverage to young adults, the
provision may affect fertility directly through expanded options for obtaining contraceptives
as well as through expanded options for obtaining pregnancy-, birth-, and
infant-related care, and these may lead to decreased or increased fertility, respectively.
In addition, the provision may also affect fertility indirectly through marriage or labor
markets, and the direction and magnitude of these effects is difficult to determine. This
paper considers the effect of the provision on fertility as well as the contributing
channels by applying difference-in-differences type methods using the 2008–2010
and 2012–2013 American Community Survey, 2006–2009 and 2012–2013 Centers
for Disease Control and Prevention abortion surveillance data, and 2006–2010 and
2011–2013 National Survey of Family Growth. Results suggest that the provision is
associated with decreases in the likelihood of having given birth and abortion rates and
an increase in the likelihood of using long-term hormonal contraceptives.

• Planning parenthood: the Affordable Care Act young adult provision and pathways to fertility