Welfare-improving policies targeting unintended fertility outcomes in the U.S. - The open case study of the Affordable Care Act’s Contraceptive Mandate.

Abstract

The efficacy of welfare-improving policies such as the ACA’s Contraception Mandate may be weakened by the effect of spurious relations between its target and means. This study comprises a broad review of the bi-univocal relation between contraception and growth, upon which further improvements in public policies’ effectiveness can be achieved. Namely, relevant cost-benefit analyses at the basis of such policies have generally relied on measurable - but limited - data sets, mainly consisting of the final (contraceptives) users’ demographic characteristics, like race, age, income and education levels, and - obviously - gender. This limited approach may have in fact impeded welfare-improving policies from timely reaching their full potential effectiveness. However, such choice was likely due to technical difficulties in observing and collecting relevant big data other than demographics, that may contribute to achieve a better understanding of the channels through which public policy can act upon its targets. Further obstacles to a functional evaluation of costs and benefits of public policy’s means seems to have stemmed from structural gender-based misinterpretations of the disposable data set. For instance, research and policy-makers have long constrained their focus onto social and economic costs only linked to women’s rights violations, neglecting the weight of such inequalities’ mirror image on men’s wealth. Moreover, incomplete information about or limited understanding of medical and other technical matters (e.g. the physiological functioning of contraceptive methods, or hormone cycles) also appeared to have been detrimental to a timely, cost-effective implementation of welfare-improving policies. This study builds upon previous research, describing possible scenarios and tools for future, more comprehensive research work. In the first section, it is presented the ongoing dispute concerning the 2010 health care reform in the US (known as ACA or Obamacare). To better understand its background and echoes at both economic and political level, dedicated sections will review the American voting system [Introduction] and some cornerstone regulations in the path towards the prosecution of equal opportunity goals [Chapters 1 and 2]. These sections will highlight the relation between the ACA’s reform and labour market policies - and the firms’ interests thereof. Chapter 3 deepens the discussion about premises and perspectives of the ACA’s Contraception Mandate. Conclusive observations and suggested perspective studies are left to the final section, which also includes two survey-based pilot studies. One assesses the effect of different types of information on shifts in the voters’ consensus to policies charged with high emotional content - preliminary results suggest that in-group dynamics, rather than empirical evidence, often play a major role in shaping the voters’ support or disfavour to measures of public policy. The second study instead aims at revealing how personal attitudes may require the policy makers to shift from an evidence-based approach to “nudging” policies, in order to better cope with the policy’s targets’ ethics-based responsiveness. Finally, it is briefly presented a recently launched project addressing the collection of data other than demographics functional to a better understanding of reproductive dynamics and fertility planning defaults.