We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of low‐educated and low‐income adults. We found that the Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured. There was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly. In terms of labor supply, estimates indicated that the Medicaid expansions had little effect on work effort despite the substantial changes in health insurance coverage. Most estimates suggested that the expansions increased work effort, although not significantly.

Key Points Question What proportion of de novo severe maternal morbidity is diagnosed after delivery discharge, and what are the most common factors and maternal characteristics associated with severe maternal morbidity among women in the US? Findings In this cohort study of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014, 14% and 16% of severe maternal morbidity among those with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after delivery discharge. The most common factors and maternal characteristics associated with severe maternal morbidity after delivery were different than those identified at delivery. Meaning The study’s findings suggest that expanding the focus of severe maternal morbidity assessment to the postdelivery discharge period could improve understanding of severe maternal morbidity and may create opportunities to improve maternity care.

Introduction: Preconception and interconception health care are critical means of identifying, managing, and treating risk factors originating prior to pregnancy that can harm fetal development and maternal health. However, many women in the U.S. lack health insurance, limiting their ability to access such care. State-level variation in Medicaid eligibility, particularly before and after the 2014 Medicaid expansions, offers a unique opportunity to test the hypothesis that increasing healthcare coverage for low-income women can improve preconception and interconception healthcare access and utilization, chronic disease management, overall health, and health behaviors. Methods:In 2018-2019, data on 58,365 low-income women aged 18-44 years from the 2011-2016 Behavioral Risk Factor Surveillance System were analyzed and a difference-in-difference analysis was used to examine the impact of Medicaid expansions on preconception health.Results: Expanded Medicaid eligibility was associated with increased healthcare coverage and utilization, better self-rated health, and decreases in avoidance of care because of cost, heavy drinking, and binge drinking. Medicaid eligibility did not impact diagnoses of chronic conditions, smoking cessation, or BMI. Medicaid eligibility was associated with greater gains in health insurance, utilization, and health among married (versus unmarried) women. Conversely, women with any (versus no) dependent children experienced smaller gains in insurance following the Medicaid expansion, but greater take-up of insurance when eligibility increased and larger behavioral responses to gaining insurance.Conclusions: Expanded Medicaid coverage may improve access to and utilization of health care among women of reproductive age, which could ultimately improve preconception health.

Preconception healthcare is heralded as an essential method of improving pregnancy health and outcomes. However, access to healthcare for low-income women of reproductive age has been limited because of a lack of health insurance. Expansions of Medicaid eligibility under the Affordable Care Act (as well as prior expansions in some states) have changed this circumstance and expanded health insurance coverage for low income women. These Medicaid expansions provide an opportunity to assess whether obtaining health insurance coverage improves pre-pregnancy and pregnancy health and reduces prevalence of adverse pregnancy outcomes. We tested this hypothesis using vital statistics data from 2011-2017 on singleton births to United States resident women ages 15 to 44. We examined associations between preconception exposure to Medicaid expansion and measures of pre-pregnancy health, pregnancy health, and pregnancy outcomes using a difference-in-differences empirical approach. Increased Medicaid eligibility was not associated with improvements in pre-pregnancy or pregnancy health measures and did not reduce prevalence of adverse birth outcomes (e.g., preterm birth increased by 0.1 percentage points [95% CI: -0.2, 0.3]). Increasing Medicaid eligibility alone may be insufficient to improve pre-pregnancy or pregnancy health and birth outcomes. Preconception programming in combination with attention to other structural determinants of pregnancy health is needed.

No abstract

Between 1995 and 2018, just over half of U.S. states enacted laws requiring private insurance plans cover medical care provided remotely. These telemedicine parity laws likely increase health care access, particularly in areas with few providers, by granting patients access to specialists or primary care providers located elsewhere. We estimate the effect of telemedicine parity laws on mortality rates of all causes and for causes of death due to conditions more frequently treated with telemedicine. Mortality rates decline postparity laws, driven by decreases in ischemic heart disease deaths. Ischemic heart disease mortality rates decline by about 6% in the difference‐in‐differences specification and 9% in the event study estimation. These effects are concentrated in counties located in the fringes of metropolitan areas. We also estimate declines in hospital admissions postparity law, consistent with improved health outcomes. Our results suggest that relaxing current telemedicine regulations would reduce mortality rates.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

It is widely believed that Medicaid reimbursement for primary care is too low and that these low fees adversely affect access to healthcare for Medicaid recipients. In this article, we exploit changes in Medicaid physician fees for primary care to study the response of primary care visits and services that are complements/substitutes with primary care, including emergency department, hospitalization, prescription drugs, and imaging. Results from our study indicate that higher Medicaid fees for primary care have modest effects. Among non-blind and non-disabled adults, we find that a 25% (or $10) increase in Medicaid fees for primary care is associated with approximately a 5% of a standard deviation increase in the number of primary care visits. For the same group, we also find that the fee increase is associated with an increase in the probability of having any primary care visits of approximately 3 percentage points. For children, changes in Medicaid fees are not significantly related to the number of primary care visits. In terms of other types of care, we find some evidence that Medicaid fees for primary care are associated with prescription drug use, and no evidence that primary care fees are associated with the use of emergency department, inpatient services, or imaging. Overall, our evidence provides, at best, limited support for the large effects of Medicaid fees on service provision sometimes asserted in policy discussions.