Birth outcomes, including infant mortality and low birth weight, are shockingly poor in the U.S. compared with peer countries. The U.S. is also the only industrialized nation with a rising maternal mortality rate, and racial disparities in maternal morbidity and mortality have launched an outcry from advocates and policymakers alike. Yet Medicaid expansion under the Affordable Care Act (ACA) has the potential to improve the health and health behaviors of women of reproductive age, prevent unintended pregnancy, and, as a result, improve birth outcomes.
In this project, the research team will use the Pregnancy Risk Monitoring Survey (PRAMS) data from 2010 to 2017 to assess whether the ACA increased intended pregnancies, reduced prepregnancy smoking, and affected contraception and birth outcomes among women covered by Medicaid. The team will also explore whether these changes reduced disparities across racial and ethnic groups.
Researchers will also examine the health impacts of various Medicaid policy choices prior to implementation of the ACA (e.g., Medicaid eligibility requirements and state family-planning programs), account for states’ early adoption of Medicaid expansion, and assess whether policy choices such as premium levels affect outcomes.
Since the early 1990s, Medicaid has been critical in providing insurance coverage for pregnant women with low incomes in the United States - pregnancy-related Medicaid coverage is available to women with incomes up to 200 percent of the federal poverty level in most states. Because pregnancy-related Medicaid eligibility is almost always more generous than eligibility for other adults, many women with low incomes not otherwise eligible for Medicaid gain coverage during their pregnancies but then lose that coverage sixty days after delivery, when their pregnancy-related eligibility expires. The American Rescue Plan Act of 2021 included an option for states to extend Medicaid coverage for twelve months postpartum. While the ACA provided coverage improvements for pregnant women outside of pregnancy, especially in states expanding Medicaid, many low-income women remain uninsured before or after their pregnancies. Building on existing studies tracking changes in Medicaid coverage and uninsurance under the law, researchers Emily M. Johnston, Stacey McMorrow, Clara Alvarez Caraveo and Lisa Dubay examined data for new mothers with Medicaid-covered prenatal care in this study published in Health Affairs.