The effect of Medicaid eligibility expansions on fertility

Zavodny, Madeline; Bitler, Marianne P.

doi:10.1016/j.socscimed.2010.05.046

Cited by 48 publications

(31 citation statements)

References 22 publications

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“…We also control for a number of time-varying state-level characteristics, such as the share of the population that is black and the share Hispanic, the Medicaid eligibility threshold for a pregnant woman, the real maximum AFDC/TANF benefit for a family of four, real median income for a family of four, the unemployment rate, the employment growth rate, the share of the population under the federal poverty level, and the share of births to unmarried women. Existing literature suggests that these characteristics might be correlated with fertility behavior (See, for example, Bitler and Zavodny 2010, Dehejia and Lleras-Muney 2004, Schmidt 2007). …”

Section: Methodology and Datamentioning

confidence: 99%

Utilization of Infertility Treatments: The Effects of Insurance Mandates

2011

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Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this article, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more-educated women should be more likely to be directly affected by the mandates than younger women and less-educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance, which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more-educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.

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Section: Methodology and Datamentioning

confidence: 99%

Utilization of Infertility Treatments: The Effects of Insurance Mandates

2011

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“…19 Similar methods for constructing a policy variable are consistently used by the literature examining the effect of Medicaid expansions on various outcomes. This measure is typically the fraction of the population eligible for Medicaid (DeLeire, Lopoo, and Simon, 2011;Zavodny and Bitler, 2010;Currie and Gruber, 2001). 20 Since the variation in INSURED is at a higher level than the individual, all standard errors are clusters at the DEMOG*STATE*YEAR level.…”

Section: Vi1 Empirical Frameworkmentioning

confidence: 99%

“…9 Several studies find different responses by white women (Joyce, Kaestner, and Kwan, 1998;Zavodny and Bitler, 2010;Yelowitz, 1994;DeLeire, Lopoo and Simon, 2011) and 6 Other outcomes include health (Courtemanche and Zapata, 2014;Miller 2012b;Yelowitz and Cannon;, insurance crowd-out (Long, 2008;Miller 2012b;Kolstad and Kowalski, 2012a;Yelowitz and Cannon, 2010), labor markets (Kolstad and Kowalski, 2012b), and adverse selection (Hackmann, Kolstrad, and Kowalski, 2012). 7 Official estimates for the uninsured rate in Massachusetts in 2008 were 2.6 percent, but Yelowitz and Cannon (2010) find that uninsured rates are underreported because the reform incentivizes people to hide their true status if they are uninsured.…”

mentioning

confidence: 99%

“…typically no population-wide effect (Zavodny and Bitler, 2010;DeLeire, Lopoo and Simon, 2011). Some also find racial differences in terms of abortion rates (Zavodny and Bitler, 2010;Joyce, Kaestner, and Kwan, 1998;Joyce and Kaestner, 1996).…”

mentioning

confidence: 99%

“…Some also find racial differences in terms of abortion rates (Zavodny and Bitler, 2010;Joyce, Kaestner, and Kwan, 1998;Joyce and Kaestner, 1996).…”

mentioning

confidence: 99%

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Health Insurance, Fertility, and the Wantedness of Pregnancies: Evidence from Massachusetts

Apostolova-Mihaylova

Yelowitz

2015

SSRN Journal

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Health insurance reform in Massachusetts lowered the financial cost of both pregnancy (by increased coverage of pregnancy-related medical events) and pregnancy prevention (by increasing access to reliable contraception and family planning). We examine fertility responses for women of childbearing age in Massachusetts and, on net, find no effect from increasing health insurance coverage. This finding, however, masks substantial heterogeneity. For married women aged 20 to 34 -who have high latent fertility and for whom pregnancies are typically wanted -fertility increased by approximately 1 percent. For unmarried women in the same age range -for whom pregnancies are typically unwanted -fertility declined by 9 percent. Fertility rates changed very little for other groups, in part because of low latent fertility or minimal gains in insurance coverage. Pregnancy wantedness increased in the aggregate through a combination of increasing wanted births and decreasing unwanted births.

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Preconception subsidized insurance: Prenatal care and birth outcomes by race/ethnicity

Palmer

2020

Health Economics

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Low-income pregnant women have been Medicaid eligible since the 1980s, but the Affordable Care Act (ACA)'s expansion of Medicaid to women preconception has the potential to improve pregnancy and birth outcomes by removing delays in Medicaid enrollment. More substantially, the ACA expanded subsidized nongroup maternity coverage. Pre-ACA, nongroup health insurance had generally excluded maternity coverage and was prohibitively expensive for low-income individuals, but the ACA's creation of the Marketplace made maternity coverage mandatory and provides income-based subsidies. I use a simulated eligibility approach to measure how these two aspects of the ACA impacted pregnancy and birth outcomes for first-time mothers, paying special attention to racial-ethnic differences. I find expanding Medicaid to women prior to pregnancy significantly improves the share of women with a prenatal care visit in the first trimester for non-Hispanic Whites and Blacks. Expansions in non-Medicaid subsidized insurance, such as Marketplace insurance, significantly reduce the share of births paid by Medicaid and increased breastfeeding across all racial and ethnic groups. Neither type of subsidized insurance had significant, robust impacts on birth outcomes.

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The effect of Medicaid eligibility expansions on fertility

Cited by 48 publications

References 22 publications

Utilization of Infertility Treatments: The Effects of Insurance Mandates

Utilization of Infertility Treatments: The Effects of Insurance Mandates

Health Insurance, Fertility, and the Wantedness of Pregnancies: Evidence from Massachusetts

Preconception subsidized insurance: Prenatal care and birth outcomes by race/ethnicity

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