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The percentage of women of reproductive age who were uninsured dropped sharply between 2013 and 2014, the first full year of implementation of the Affordable Care Act (ACA). The decrease among women aged 15–44, calculated by the Guttmacher Institute, mirrors broader national trends reported by the U.S. Census Bureau. This includes steeper drops in the uninsured rate in states that expanded Medicaid under the ACA compared with the rates in those states that did not. However, despite these improvements, significant disparities in insurance status remain among reproductive-age women based on their income and whether they live in a Medicaid expansion state.

Key Findings:

• The proportion of reproductive-age women without health insurance declined by more than one-fifth between 2013 and 2014, from 17.9% to 13.9%. The change appears to have been driven primarily by gains in Medicaid coverage (from 17.2% to 20.2%). There was a small increase in the proportion of women with private health insurance, from 60.9% to 62.1%.
• Gains in insurance coverage among reproductive-age women who live below the poverty line were substantial as well. The uninsured rate dropped by one-fifth, from 32.1% in 2013 to 25.6% in 2014. Still, poor women of reproductive age were almost twice as likely to be uninsured in 2014 as reproductive-age women overall (25.6% vs. 13.9%).
• States that had implemented the ACA’s Medicaid expansion for 2014 experienced both steeper declines and lower overall levels in their uninsured rate among women of reproductive age. Only 10.6% (down from 15.6%) of women aged 15–44 were uninsured in expansion states, compared with 17.7% (down from 20.5%) in non-expansion states.
• While Medicaid expansion states had higher levels of Medicaid coverage to begin with, that gap widened further in 2014, with 23.2% of reproductive-age women in expansion states ensured through Medicaid, compared with 16.7% in non-expansion states.

The gains in the proportion of women aged 15–44 who have insurance coverage has significant implications for access to health care in general, and to sexual and reproductive health care in particular. Medicaid has long offered a very robust package of sexual and reproductive health care services, including family planning services and supplies without out-of-pocket costs for enrollees. And the ACA has spurred significant improvements in private plans’ coverage; most notably, the contraceptive coverage guarantee ensures that privately insured women can access the full range of 18 Food and Drug Administration–approved contraceptive methods for women without out-of-pocket costs.

Multiple Guttmacher studies have documented these important gains. Most recently, researchers found a steep decline in out-of-pocket costs for hormonal IUDs after implementation of the ACA’s contraceptive coverage guarantee. Another study released in 2014 found similarly large improvements for oral contraceptive pills and other popular contraceptive methods. This means that more women can now choose a birth control method based on what works best for them, as opposed to what they can afford.

The ACA’s impact is also being felt among safety-net family planning providers, as increasing numbers of family planning visits are covered by insurance. An analysis of data from a group of 32 safety-net centers supported by the Title X program found that the overall proportion of uninsured client visits at these centers decreased from 41% during the last three quarters of 2013 to 36% during that same period in 2014, driven by increases in visits paid for by both Medicaid and by private insurance.

Note: The Guttmacher Institute calculated the above data on changes in insurance status using the 2015 Current Population Survey Annual Social and Economic Supplement (CPS ASES).