Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies

Johnston, Emily M.; Strahan, Andrea E.; Joski, Peter; Dunlop, Anne L.; Adams, E. Kathleen

doi:10.1016/j.whi.2017.11.005

Cited by 68 publications

(71 citation statements)

References 29 publications

(45 reference statements)

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“…These would be important directions for future research, given documented differences in perinatal insurance coverage by race, ethnicity, and parental status. 14,33 Fifth, we were not able to adjust for multiple comparisons in our analyses.…”

Section: Study Data and Methodsmentioning

confidence: 99%

“…This change led to an immediate and large increase in insurance coverage among low-income women of reproductive age in expansion states when compared with nonexpansion states. 14 In general, women without children experienced the largest changes in insurance coverage after the ACA Medicaid expansions, although women with children in states with low parental eligibility thresholds also experienced large increases in insurance coverage. The Medicaid expansions and other ACA coverage expansions improved access to care for reproductive-age women, including increased access to physicians and fewer cost barriers to receiving care.…”

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confidence: 99%

“…The Medicaid expansions and other ACA coverage expansions improved access to care for reproductive-age women, including increased access to physicians and fewer cost barriers to receiving care. [14][15][16] These changes may translate into improved maternal and infant health if they support the prevention and treatment of important medical and behavioral risk factors during nonpregnancy periods.…”

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confidence: 99%

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Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception

2020

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The period before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time. We evaluated whether increased access to health insurance under the Affordable Care Act Medicaid expansions affected ten preconception health indicators, including the prevalence of chronic conditions and health behaviors, birth control use and pregnancy intention, and receipt of preconception health services. By comparing changes in outcomes for low-income women in expansion and nonexpansion states, we document greater preconception health counseling, prepregnancy folic acid intake, and postpartum use of effective birth control methods among low-income women associated with Medicaid expansion. We do not find evidence of changes on the other preconception health indicators examined. Our findings indicate that expanding Medicaid led to detectable improvements on a subset of preconception health measures.

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Section: Study Data and Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception

2020

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“…A random digit dialing method is used to select a representative sample of respondents from the noninstitutionalized adult population. BRFSS has been extensively used to research health impacts of the ACA [5, 18–21]. It is particularly appropriate because its large number of observations, more than 300,000 per year, allows us to decipher the effects of the ACA.…”

Section: Methodsmentioning

confidence: 99%

Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

Joseph

2019

Preprint

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32Objectives: To explore whether state-level political-sentiment is associated with gains in 33 insurance post Affordable Care Act (ACA). This is especially relevant given the lawsuit brought 34 by several Republican-leaning states against the ACA, and the ruling of one Texas federal judge 35 that the ACA is unconstitutional, which potentially jeopardizes ACA's future. 36 Methods: Multivariate linear-probability models are estimated using data from the Behavioral 37 Risk Factor Surveillance Systems for 2011-2017. The outcome is self-reported insurance status. 38 States are placed in quartiles based on votes for President Obama in 2008 and 2012 elections. 39 Starting 2014, ACA health exchanges became active and several states expanded Medicaid, so 40 2014 onwards is considered as the 'post-ACA' period. Models are estimated for all adults under 41 65-years and for young adults under 35-years. All models control extensively for respondent socio-42 economic-demographic characteristics and state characteristics.43 Results: In the pre-ACA baseline period, respondents in states with higher Anti-Obama-voting 44 (AOV) were less likely to have insurance. For example, residents in highest AOV-quartile states 45 were 8.0-percentage-points less likely (p<0.001) to have insurance than those in the lowest AOV-46 quartile states. Post-ACA, fewer high AOV-quartile states expanded Medicaid, and overall 47 48 Medicaid-expansion, residents in higher AOV states saw higher insurance gains. For example, all 49 adults had 2.8-percentage points higher likelihood (p<0.01) and young adults had 4.9-percentage 50 point higher likelihood (p<0.01) of getting insurance in the highest AOV-quartile states compared 51 to the lowest AOV quartile states. Minorities and those with chronic-conditions had larger 52 insurance gains across the country post-ACA, but the extent of these gains did not differ by state 53 AOV levels. 3 54 Conclusions: State AOV and insurance gains from ACA appear to be incongruent. Policymakers 55 and stakeholders should be aware that non-Medicaid residents of higher-AOV states might 56 potentially lose the most if ACA is revoked. 58 The Patient Protection and Affordable Care Act (hereafter ACA) very substantially 59 changed the health insurance landscape in the United States, and scientific research indicates that 60 although there were significant increases in rates of health insurance coverage in the U.S. after 61 its passage, yet opinions about the ACA remain deeply divided along political lines [1-6]. The 62Kaiser Health Tracking Poll [7] shows that overall unfavorable ratings of ACA dropped from a 63 high of 53% in July 2014 to 40% in November 2018. However, among those who identify as 64 Republicans, approximately 75% continue to view it unfavorably, while less than 20% of those 65 who identify as Democrats and about 45% of those who identify as Independents do so. The 66 ACA's future also remains uncertain under the current administration. One key provision, the 67 'individual mandate' that requires indiv...

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“…In contrast, women in expansion states can remain covered after delivery if still income eligible as an expansion adult and thus benefit from continuous coverage and better access to care, including earlier entry into prenatal care, if they were to become pregnant again. A study published in 2017 and using Behavioral Risk Factor Surveillance System data found that Medicaid expansions significantly decreased the uninsured rate among poor (<100% FPL) women of reproductive age (19-44 years) between 2012 and 2013 and 2014 and 2015 by 13.2% (48% were uninsured in 2012-2013 and 39.6% were uninsured in 2014-2015) (Johnston, Strahan, Joski, Dunlop, & Adams, 2018). In 2014, the most recent year available for national enrollment estimates, 25 million of the 69.3 million individuals enrolled in Medicaid were women older than 19 years of age (representing 36% of total Medicaid enrollment); of these 25 million women, the vast majority, 67%, were of reproductive age (19-49 years old) (Kaiser Family Foundation, 2019).…”

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confidence: 99%

An Analysis of Payment Mix Patterns of Preterm Births in a Post-Affordable Care Act Insurance Market: Implications for the Medicaid Program

Meltzer

Markus

2020

Women's Health Issues

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Background: The United States has a relatively high preterm birth rate compared with other developed nations. Before the enactment of the Affordable Care Act in 2010, many women at risk of a preterm birth were not able to access affordable health insurance or a wide array of preventive and maternity care services needed before, during, and after pregnancy. The various health insurance market reforms and coverage expansions contained in the Affordable Care Act sought in part to address these problems. This analysis aims to describe changes in the patterns of payer mix of preterm births in the context of a post-Affordable Care Act insurance market, explore possible factors for the observed changes, and discuss some of the implications for the Medicaid program. Methods: We applied a repeated cross-sectional study design to explore payment mix patterns of all births and preterm births between 2011 and 2016, using publicly available National Vital Statistics Birth Data. We included an equal number of years with payment source available in the dataset before and after January 1, 2014, when the coverage expansions became effective. Results: We found a small relative change in payment mix during the study period. Private health insurance (PHI) paid for a higher percentage of all births and this rate increased steadily between 2011 and 2016. Preterm births paid by PHI increased by 1.4 percentage points between 2011 and 2016 and self-pay/uninsured preterm births decreased by 0.3 percentage points over the same time period. Medicaid had the highest, and a relatively stable, preterm birth coverage percentage (48.9% in 2011, 49.2% in 2014, and 48.9% in 2016). Medicaid was also more likely to pay for preterm births than PHI, but this likelihood decreased by more than one-half after 2014 (8.2% in 2013 vs. 3.8% in 2014). Conclusions: After the 2010 reforms, Medicaid remained a constant source of coverage for the most vulnerable women in society when faced with the high cost of a preterm birth. Nationwide, of the 64 million women ages 15 to 44, 4% gained PHI (directly purchased or employer sponsored) and another 4% Medicaid, with a concomitant 8% decrease in uninsured women of reproductive age between 2013 and 2017. More research is needed to conclude with certainty that the reforms worked as intended, but the important role of Medicaid as a financial safety net is undeniable.

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Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies

Cited by 68 publications

References 29 publications

Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception

Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception

Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

An Analysis of Payment Mix Patterns of Preterm Births in a Post-Affordable Care Act Insurance Market: Implications for the Medicaid Program

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