State And Federal Coverage For Pregnant Immigrants: Prenatal Care Increased, No Change Detected For Infant Health

Abstract

Expanded health insurance coverage for pregnant immigrant women who are in the United States lawfully as well as those who are in the country without documentation may address barriers in access to pregnancy-related care. We present new evidence on the impact of states' public health insurance expansions for pregnant immigrant women (both state-funded and expansions under the Children's Health Insurance Program) on their prenatal care use, mode of delivery, and infant health. Our quasi-experimental design compared changes in immigrant women's outcomes in states expanding coverage to changes in outcomes for nonimmigrant women in the same state and to women in nonexpanding states. We found that prenatal care use increased among all immigrant women following coverage expansion and that cesarean section increased among immigrant women with less than a high school diploma. We found no effects on the incidence of low birthweight, preterm birth, being small for gestational age, or infant death. State public insurance programs that cover pregnant immigrant women appear to have improved prenatal care utilization without observable changes in infant health or mortality.

Expanding Prenatal Care to Unauthorized Immigrant Women and the Effects on Infant Health

“…12,13 Our study corroborates these important findings related to prenatal care access, which a growing body of literature links to improved health and economic indicators in the subsequent generation. 28 Moreover, because we are able to specifically isolate immigrant women who gain coverage through Oregon's expansion, we are better able to measure related health outcomes.…”

“…23 As of 2015, thirty-two states and the District of Columbia have opted to provide some level of prenatal care for unauthorized immigrant women through Medicaid or CHIP. 12 Funding for CHIP is extended through 2017 and the scope of the program at renewal is likely to be a topic of debate.…”

Association of the Affordable Care Act Dependent Coverage Provision With Prenatal Care Use and Birth Outcomes

“…Consistent with numerous studies of health insurance expansions, including the dependent coverage provision, we examined outcomes in 3 domains: insurance status, access to care, and health. 1,3,[14][15][16] This approach is supported by evidence from a variety of settings showing that coverage changes can lead to changes in utilization and health outcomes. 17 As a proxy for insurance status, we analyzed payment for birth-Medicaid, private insurance, or self-pay.…”

Why Physicians Should Advocate for Undocumented Immigrants' Unimpeded Access to Prenatal Care

“…18 Recent research indicates that though the unborn child option improves prenatal care utilization in this population, there are mixed findings as to whether it improves birth outcomes relative to states in which there is no prenatal policy. [19][20][21] Policy restrictions on coverage for pregnant undocumented immigrants create ethical challenges for clinicians as well. When clinicians are caught between a professional obligation to provide comprehensive prenatal care to this population and policy restrictions on which services are and are not covered, it can cause significant moral distress, defined by Nancy Berlinger as "an acute feeling of risk to one's own personal and professional integrity that is associated with the perception of powerlessness to prevent some wrong."…”