Two new studies from Oregon State University (OSU) have found that the state’s expansion of Medicaid in 2014 resulted in increased prenatal care among low-income women and improved health outcomes for newborn infants.

Before the Medicaid expansion as part of the Affordable Care Act, low-income women who were not otherwise eligible for Medicaid became eligible when they were pregnant. Experts estimated that expanding Medicaid to include everyone earning up to 138% of the federal poverty level would extend coverage to 77,000 more women of childbearing age.

In the 3 years following the expansion, 1 study found that Oregon saw an almost 2 percentage point increase in first trimester prenatal care utilization, relative to 18% of the pre-expansion population who lacked any access to prenatal care in earlier stages of pregnancy. The second study found that during the same 3-year period, Medicaid expansion was associated with a 29% reduction in low birthweight among infants born to women on Medicaid, as well as a 23% reduction in preterm births.

“This means that women are getting preconception care before they’re pregnant,” said lead author Marie Harvey, PhD, MPH, associate dean for research in OSU’s College of Public Health and Human Sciences, in a press release. “Then when they become pregnant, they’re more easily able to get prenatal care.”

According to the investigators, establishing a connection with a primary care provider prior to pregnancy allows women to receive holistic medical care and public health care to improve their overall well-being.

“It’s much broader than just 1 specific intervention or health condition,” said co-author Susannah Gibbs, PhD, MSPH, in a press release. “You might think about smoking cessation or nutrition—all these things that are kind of an ongoing conversation between a health care provider and someone who might in the future become pregnant. They might receive those interventions that improve their overall health and lead them to be in a healthier state when they do become pregnant.”

Because the Medicaid expansion did not change women’s eligibility for Medicaid during pregnancy and there was already high utilization of pregnancy services, the investigators focused on the impact of greater continuity of care, in which individuals’ access to services was not split into different health states, such as pregnant versus not pregnant.

The researchers found almost twice the magnitude of gains in pre-pregnancy enrollment in Medicaid among Hispanic women compared with non-Hispanic white women. Furthermore, increased pre-pregnancy enrollment in Medicaid likely contributed to positive impacts on low birthweight and pre-term births, as women with health coverage had greater access to preventive care and preconception care, according to the study.

Harvey said these findings align with the “life course perspective” on health care, in which providing women access to health care early in their lives leads to better overall health status and healthier pregnancies. Infants are then more likely to be born healthy and to be connected with health services and primary health care from an early age.

“Once you have people in that medical care system, it is an opportunity to be connected with those individuals who are in great need of other interventions beyond medical care that reach into the broader public health space,” Gibbs concluded.

REFERENCE
OSU studies find Oregon’s Medicaid expansion improved prenatal care access, birth outcomes [news release]. Oregon State University; December 31, 2020. https://today.oregonstate.edu/news/osu-studies-find-oregon%E2%80%99s-medicaid-expansion-improved-prenatal-care-access-birth-outcomes. Accessed January 4, 2021.