Impacts of Medicaid Expansion on Health Among Women of Reproductive Age

Abstract

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.

Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception

“…Supporting this possibility, prior research suggests that treatment of diabetes increased under the ACA Medicaid expansions, [39][40][41] as did treatment of diabetes and hypertension among women of reproductive age, even as diagnosis rates for these conditions did not change. 16 These findings have direct relevance to ongoing policy discussions. We provide the first evidence that the ACA Medicaid expansions led to increased preconception health counseling, folic acid intake, and effective postpartum contraception use.…”

“…This is consistent with prior research that found no impact of Medicaid eligibility expansions on body mass index or on diagnoses of diabetes or hypertension for women of reproductive age. 16 Our data span five years after the Medicaid expansions, but this window may be too short to expect detectable changes in the prevalence of chronic conditions or many health behaviors. Although the changes we did observe were not statistically significant, the confidence intervals on our estimates included values that could be considered clinically meaningful changes.…”

“…A recent analysis examined the health of women of reproductive age and found no changes in chronic conditions, smoking cessation, or body mass index associated with the ACA Medicaid expansions, using data through 2016. 16 The authors did find, however, improved self-reported health and decreased binge drinking associated with expanded Medicaid eligibility.…”

“…The Medicaid expansions and other ACA coverage expansions improved access to care for reproductive-age women, including increased access to physicians and fewer cost barriers to receiving care. [14][15][16] These changes may translate into improved maternal and infant health if they support the prevention and treatment of important medical and behavioral risk factors during nonpregnancy periods.…”

Post-ACA, More Than One-Third Of Women With Prenatal Medicaid Remained Uninsured Before Or After Pregnancy

“…Numerous studies have tracked changes in Medicaid coverage and uninsurance under the law for women of reproductive age and mothers at various points relative to pregnancy. [9][10][11][12][13][14][15] Specifically, the ACA Medicaid expansion has reduced uninsurance among women of reproductive age overall, 10,11 and particular-ly among new mothers in the year after delivery. 12 Expansion has also increased preconception and postpartum Medicaid coverage.…”