Non-monetary obstacles to medical care: Evidence from postpartum contraceptives

We use changes to Medicaid immediate postpartum policy to test whether non-monetary costs are meaningful obstacles to health care. Medicaid in several states currently covers long-acting reversible contraceptives (LARCs, including IUDs and implants) immediately following delivery of a child, eliminating much of the time-cost and stress associated with obtaining a LARC. Postpartum LARCs can reduce unintended and short-interval pregnancies, which are associated with adverse neonatal outcomes. Births that occur in Catholic-owned hospitals are an ideal control group, because these hospitals are prohibited from offering family-planning services, including LARCs. Using difference-in-differences and individual-level administrative data from Louisiana and New York, we find eliminating non-monetary obstacles increases take-up of a high-value and highly effective form of contraception. Additionally, we find no evidence of crowd-out of outpatient LARCs.