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In 2002, 15.4% of women of childbearing age in the USA reported struggles with infertility. Over the past 3 decades, drugs and assisted reproductive technologies have been developed to treat infertility, but treatment is costly. Since 1985, several states have adopted insurance mandates that require providers to cover or offer infertility treatments. In this paper, I examine the impact of strong mandate-to-cover laws on multiple births, which are associated with infertility treatment use. I also investigate whether the laws had heterogeneous treatment effects.

Using birth certificate data from 1980–2002, I show that the laws had a small and statistically insignificant impact on multiple birth rates. However, I find that there were over 5300 mandate-induced triplet and higher-order births over the period, for which the delivery costs alone are estimated to be over $900 million. Increases in multiple birth rates are only observed for women over 30 and are greater for women who are married, white, or have a college degree. This is consistent with previous work, which finds that the mandates did not reduce disparities in treatment use. Copyright © 2012 John Wiley & Sons, Ltd.