Insurance Coverage for Pregnant Women Improves for ACA Medicaid Expansion

A new study shows that the Affordable Care Act (ACA) Medicaid expansion increased preconception and postpartum Medicaid coverage and led to significant declines in uninsurance and insurance care; however, the Medicaid expansion increased perinatal health care use or improved infant birth outcomes overall, according to a Columbia Mailman School of Public Health press release.

“In earlier research before the ACA, we found high rates of uninsurance among reproductive-aged women,” said senior study author Jamie Daw, PhD, Columbia Mailman School assistant professor of health policy and management, in the press release. “In addition, insurance churn—moving between insurance and uninsurance or switching insurers—was common around pregnancy, and high rates of coverage instability may have contributed to lower access to care and poorer maternal and child health outcomes. The result disproportionately impacted low-income people and members of racial and ethnic minority groups who qualify for pregnancy Medicaid coverage.”

Daw and colleagues analyzed data published between January 2014 and April 2021. The data were used to evaluate effect of the ACA state Medicaid on insurance coverage, health care use, and health outcomes measured between 1 month prior to conception through 1 year postpartum, and neonatal outcomes within 27 days of birth. The research team identified 35 unique studies that met their screening criteria, according to the press release.

The results showed that increases in Medicaid coverage were greater during the preconception and postpartum periods than at delivery because pregnant people already qualified for Medicaid from conception to 60 days after birth before the ACA.

“Despite large coverage increases before and after pregnancy, we found limited evidence that the ACA Medicaid expansion improved overall perinatal health care use or health outcomes in the first few years after implementation,” said first author Meghan Bellerose, '21 MPH, PhD student at Brown University School of Public Health, in the press release. “However, one study found that the ACA Medicaid expansion was associated with reduced racial disparities in birth outcomes such as preterm birth, and another found a reduction in overall maternal mortality. These results are promising and merit further exploration as the US continues to pursue strategies to reduce racial disparities in maternal mortality and morbidity.”

Daw added that the findings suggest that Medicaid expansion to low-income adults is a highly effective strategy to increase preconception and postpartum health insurance coverage.

“Our ability to observe corresponding changes in health care use and outcomes is partly related to a lack of data collection on preconception and postpartum outcomes in the US,” Daw said in the press release. “Our results are highly relevant to the recent maternal healthcare call to action from the White House and the postpartum Medicaid provisions within the Build Back Better Act, suggesting that these provisions will result in large coverage gains, but more data will be needed for rigorous evaluation of the impact of Medicaid policy changes on maternal health disparities.”

REFERENCE

ACA Medicaid Expansion Improves Insurance Coverage for Pregnant People. Columbia Mailman School of Public Health. January 5, 2022. Accessed January 5, 2022. https://www.publichealth.columbia.edu/public-health-now/news/aca-medicaid-expansion-improves-insurance-coverage-pregnant-people