Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth

Abstract

IMPORTANCE Low birth weight and preterm birth are associated with adverse consequences including increased risk of infant mortality and chronic health conditions. Black infants are more likely than white infants to be born prematurely, which has been associated with disparities in infant mortality and other chronic conditions. OBJECTIVE To evaluate whether Medicaid expansion was associated with changes in rates of low birth weight and preterm birth outcomes, both overall and by race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS Using US population-based data from the National Center for Health Statistics Birth Data Files (2011-2016), difference-indifferences (DID) and difference-indifference in differences (DDD) models were estimated using multivariable linear probability regressions to compare birth outcomes among infants in Medicaid expansion states relative to non-Medicaid expansion states and changes in relative disparities among racial/ethnic minorities for singleton live births to women aged 19 years and older. EXPOSURES State Medicaid expansion status and racial/ethnic category. MAIN OUTCOMES AND MEASURES Preterm birth (<37 weeks' gestation), very preterm birth (<32 weeks' gestation), low birth weight (<2500 g), and very low birth weight (<1500 g). RESULTS The final sample of 15 631 174 births (white infants: 8 244 924, black infants: 2 201 658, and Hispanic infants: 3 944 665) came from the District of Columbia and 18 states that expanded Medicaid (n = 8 530 751) and 17 states that did not (n = 7 100 423). In the DID analyses, there were no significant changes in preterm birth in expansion relative to nonexpansion states (preexpansion to postexpansion period, 6.80% to 6.

Medicaid expansion and infant mortality: the (questionable) impact of the Affordable Care Act

“…Brown et al use a difference-in-differences estimator to examine the impact of Medicaid expansion on low birth weight and preterm birth, both of which can be precursors to infant mortality. 6 They find no statistically significant impact of Medicaid expansion on low birth weight or preterm birth overall, but find a decrease in incidence in low birth weight and preterm births for black infants in states that expanded Medicaid, and therefore a decrease in perinatal health disparities for black babies.…”

“…Researchers have attempted to examine the relationship between PPACA-related Medicaid expansion and infant mortality and perinatal health outcomes such as low birth weight and preterm birth. 4–7 One might expect that more generous eligibility requirements for publicly provided health insurance (Medicaid) may lead to a decrease in infant mortality as well as fewer poor perinatal health outcomes. Expansion of Medicaid would lead more women who were previously uninsured or underinsured to have affordable access to care before pregnancy.…”

Cuba’s success in child health: what can one learn?

“…LBW babies (<2.5 kg) account for 5.3% of all births in Cuba (2015 data) 7. In contrast, in the USA, LBW babies account for 8.3% births (2017 data) 8. Infant mortality rates are significantly higher for LBW babies.…”

Capsule Commentary on Gordon et al., The Impact of Medicaid Expansion on Continuous Enrollment: a Two-State Analysis

“…The study complements prior research finding that in the context of generous Medicaid eligibility for pregnant women, expanding Medicaid for nonpregnant adults improves prenatal care 4 and disparities in preterm birth. 5…”