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Implementing and Evaluating Structural Interventions in Medicaid to Promote Racial Equity in Pregnancy and Child Health

The burdens of racist policies have produced vastly worse pregnancy and birth outcomes for Black and Native populations relative to White populations in the United States. Because state Medicaid programs are the largest single payer for pregnancy care in the country, changes to Medicaid policies are an important way to implement structural interventions to promote racial equity.  

This project will investigate the implementation of and effects of 3 equity-focused policies in Pennsylvania's Medicaid program: a payment incentive available to Medicaid health plans that achieve excellent outcomes for Black pregnant persons and young children; bundled payment model for pregnancy care that rewards providers who reduce racial inequities; and implementation of Regional Accountable Health Councils to design equity-focused community interventions. The results will inform discussion around how state Medicaid programs can use structural interventions to promote racial equity and justice. 

Impacts of the Affordable Care Act on Equity in Health Care Access and Utilization for Indigenous Women

Indigenous women are at alarmingly elevated risk for increased maternal morbidity and mortality. A lack of access to affordable, continuous, and high-quality health care from preconception through pregnancy and postpartum has been identified as an important, modifiable risk factor. This project will quantitatively assess whether the impacts of the Affordable Care Act (ACA) on health care access and utilization were equitable between Indigenous and non-Indigenous women.  

This work will increase understanding of how historical, cultural, and healthcare contexts unique to specific Indigenous nations, regions, and tribes moderated the ACA's impact on women's access to and utilization of preventive health care. The transition to a new US presidential administration—and ongoing conversations about the future of the ACA—represent opportunities to translate findings from this research to improve equity in access to and utilization of care for Indigenous reproductive age women. 

The Impact of Vaccine Mandates and Exemptions on Childhood Immunization Coverage

Childhood vaccines play a major role in minimizing the incidence of vaccine-preventable disease. While all states accommodate medical vaccine exemptions, certain states also allow for waivers on the basis of religious or philosophical objections.

This study will investigate if and how changes in states' vaccination exemption laws affect subsequent vaccination coverage rates. The researchers will focus on measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), and DTP-MMR combined with the Polio vaccine (the 4:3:1 series), as well as chickenpox (varicella), Polio, Hepatitis B, and Pneumococcal (PCV). 

Data on the evolution of exemption laws will be combined with the National Immunization Survey in the period 2008-2018 to establish the degree to which vaccine uptake is affected by non-medical exemptions as a whole. The study will also explore the existence of differing types of non-medical exemptions and the different attributes controlling existing exemption laws.

The overarching purpose of the research is to understand whether existing vaccination policies and regulations are compatible with the public health objectives of improving immunization coverage and population health.

Date Funded