Medicaid expansions, preconception insurance, and unintended pregnancy among new parents

Abstract

Objective: To assess the relationship between recent changes in Medicaid eligibility and preconception insurance coverage, pregnancy intention, health care use, and risk factors for poor birth outcomes among first-time parents. Data Source: This study used individual-level data from the national Pregnancy Risk Assessment Monitoring System (2006-2017), which surveys individuals who recently gave birth in the United States on their experiences before, during, and after pregnancy. Study Design: Outcomes included preconception insurance status, pregnancy intention, stress from bills, early prenatal care, and diagnoses of high blood pressure and diabetes. Outcomes were regressed on an index measuring Medicaid generosity, which captures the fraction of female-identifying individuals who would be eligible for Medicaid based on state income eligibility thresholds, in each state and year. Data Collection/Extraction Methods: The sample included all individuals aged 20-44 with a first live birth in 2009-2017.Principal Findings: Among all first-time parents, a 10-percentage point (ppt) increase in Medicaid generosity was associated with a 0.7 ppt increase (P = 0.017) in any insurance coverage and a 1.5 ppt increase (P < 0.001) in Medicaid coverage in the month before pregnancy. We also observed significant increases in insurance coverage and early prenatal care and declines in stress from bills and unintended pregnancies among individuals with a high-school degree or less. Conclusions:Increasing Medicaid generosity for childless adults has the potential to improve insurance coverage in the critical period before pregnancy and help improve maternal outcomes among first-time parents.

Association of Prenatal Care Expansion With Use of Antidiabetic Agents During Pregnancies Among Latina Emergency Medicaid Recipients With Gestational Diabetes

“… 33 Medicaid expansion under the Patient Protection and Affordable Care Act significantly reduced uninsurance rates, improved adequacy of prenatal care, and reduced parental stress. 34 , 35 , 36 Nationally, supporters have advocated for 12 months of continuous postpartum Medicaid coverage, recognizing the critical role this period plays for both maternal and infant health. 37 Poorly controlled diabetes and hypertension are risk factors for the most common causes of severe maternal morbidity and mortality in the US.…”

Coverage Effects of the ACA's Medicaid Expansion on Adult Reproductive-Aged Women, Postpartum Mothers, and Mothers with Older Children

“…Descriptive analyses also suggest that uninsurance among new mothers (McMorrow & Kenney, 2018 ) and insurance disruptions (i.e., churn) between preconception and postpartum (Daw et al, 2019 ) are both lower in expansion states than non-expansion states. Other research has shown increases in insurance coverage among new mothers and preconception coverage (Adams et al, 2019 ; Clapp et al,; 2018 ; Daw et al, 2020 ; Geiger et al, 2021 ; Lyu & Wehby, 2021 ). Primarily due to the categorical eligibility of pregnant women and postpartum mothers up to 60 days, we expect there are differences even within the population of reproductive-aged women.…”

“…First, like Daw and Sommers ( 2019 ), Johnston et al ( 2018 ), and Lyu and Wehby ( 2021 ) we study all reproductive-aged women. Second, as in Johnston et al ( 2018 ), McMorrow and Kenney ( 2018 ), Daw et al ( 2019 ), Clapp et al ( 2018 ), Adams et al ( 2019 ), Daw et al ( 2020 ), Lyu and Wehby ( 2021 ), and Geiger et al ( 2021 ) we examine Medicaid expansions specifically. We extend McMorrow and Kenney ( 2018 ) and Daw et al ( 2019 ) by rigorously analyzing the causal impact of the expansions.…”

“…Further, we also extend Johnston et al ( 2018 ) by estimating the effects on Medicaid coverage specifically (rather than health insurance coverage) and by examining variation in the effects of Medicaid expansions within the population of mothers by time of last pregnancy. Finally, we build upon Clapp et al ( 2018 ), Adams et al ( 2019 ), Daw et al ( 2020 ), and Geiger et al ( 2021 ) by producing a national examination of the expansions. Specifically, we use nationally representative data to estimate the effect of ACA’s Medicaid expansions on Medicaid coverage of low-income reproductive-aged women, and whether there are different relative effects for women without children, women who have given birth in the past year, and women who have a child older than one year.…”

Untitled

“…Unintended pregnancy is considered as one of the most important reproductive health problems due to its negative outcomes [1]. It includes the case of an untimely (wanted but not planned) and unwanted pregnancy [2].…”