Impacts of Medicaid Expansion Before Conception on Prepregnancy Health, Pregnancy Health, and Outcomes

Abstract

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.

Analysis of State Medicaid Expansion and Access to Timely Prenatal Care Among Women Who Were Immigrant vs US Born

“…Current literature examining the influence of nonpregnancy Medicaid expansion on maternal health care use in the overall population has mixed findings. 23 , 24 , 25 , 26 , 27 , 28 Our analysis builds on this research with a new focus on a large proportion of birthing individuals not eligible for Medicaid in most areas in the US.…”

ACA Medicaid Expansions and Maternal Morbidity

“…While there exist hundreds of studies on the effects of ACA Medicaid expansions, only a few specifically focus on maternal health (Bellerose et al 2022). Three recent papers are highly relevant to our study; studies by Palmer (2020), Margerison et al (2021), and Eliason (2020), all of which address the question of whether the ACA Medicaid expansions affected different aspects of maternal health. Palmer (2020) and Margerison et al (2021) both use the Vital Statistics birth certificate data to examine the effects of ACA Medicaid expansions on a variety of maternal and infant health outcomes.…”

“…Three recent papers are highly relevant to our study; studies by Palmer (2020), Margerison et al (2021), and Eliason (2020), all of which address the question of whether the ACA Medicaid expansions affected different aspects of maternal health. Palmer (2020) and Margerison et al (2021) both use the Vital Statistics birth certificate data to examine the effects of ACA Medicaid expansions on a variety of maternal and infant health outcomes. Margerison et al (2021) examine measures of prepregnancy health (cigarette smoking, BMI, diabetes, hypertension); health and health behaviors during pregnancy (timing of prenatal care, cigarette smoking, diabetes, hypertension, eclampsia) and infant health outcomes (preterm birth and birth weight for gestational age).…”

Impacts of the Affordable Care Act’s Medicaid Expansion on Live Births

“…19 Similarly, studies of the impact of the ACA Medicaid expansions on a range of reproductive-health outcomes including preterm birth and maternal mortality have reported heterogenous associations across sociodemographics. 5,6,8,[23][24][25] Notably, to the best of our knowledge, no studies have examined associations between ACA Medicaid expansions and births rates, even though these current expansions have more scope to affect live births than previous expansions. In this article, we leverage the 2012 Supreme Court ruling (National Federation of Independent Business vs. Sebelius) that made Medicaid expansion optional for each US state to investigate two questions.…”

“…19 Similarly, studies of the impact of the ACA Medicaid expansions on a range of reproductive-health outcomes including preterm birth and maternal mortality have reported heterogenous associations across sociodemographics. 5,6,8,23–25…”