Pre Pregnancy Health Care Engagement Among American Indian and Alaska Native People Before and After the Affordable Care Act

Overview

This study investigates changes in pre pregnancy health care interactions among American Indian and Alaska Native (AI/AN) birth givers following the implementation of the Affordable Care Act (ACA). It compares the results with non-Hispanic White (NHW) birth givers to assess health equity in the effects of the ACA. Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) were used, covering the period from 2009 to 2015.

Key Findings

• Among AI/AN birth givers, increases in pre pregnancy Medicaid coverage (10 percentage points), multivitamin/prenatal use (5 percentage points), and teeth cleaning (9 percentage points) were observed post-ACA. These increases were larger than those observed for NHW birth givers.
• Both AI/AN and NHW birth givers experienced significant increases in pre pregnancy preventive health care screenings (12-18 percentage points) and conversations with providers about family medical history (8-10 percentage points).
• Although the ACA led to improved pre pregnancy health care coverage and use among AI/AN birth givers, the study highlights that pre-ACA disparities persisted, with AI/AN birth givers experiencing worse outcomes than NHW birth givers, even after the ACA.

Implications for Policy and Practice

While the ACA contributed to increased health care engagement among AI/AN birth givers, the persistence of disparities suggests that further efforts are needed to address inequities in health outcomes. Policy interventions that go beyond health care access, such as addressing the structural and systemic barriers faced by AI/AN communities, are necessary to close these gaps.