Impacts of Medicaid Expansion Prior to Conception on Pre-pregnancy Health, Pregnancy Health, and Outcomes.

Abstract

Preconception healthcare is heralded as an essential method of improving pregnancy health and outcomes. However, access to healthcare for low-income women of reproductive age has been limited because of a lack of health insurance. Expansions of Medicaid eligibility under the Affordable Care Act (as well as prior expansions in some states) have changed this circumstance and expanded health insurance coverage for low income women. These Medicaid expansions provide an opportunity to assess whether obtaining health insurance coverage improves pre-pregnancy and pregnancy health and reduces prevalence of adverse pregnancy outcomes. We tested this hypothesis using vital statistics data from 2011-2017 on singleton births to United States resident women ages 15 to 44. We examined associations between preconception exposure to Medicaid expansion and measures of pre-pregnancy health, pregnancy health, and pregnancy outcomes using a difference-in-differences empirical approach. Increased Medicaid eligibility was not associated with improvements in pre-pregnancy or pregnancy health measures and did not reduce prevalence of adverse birth outcomes (e.g., preterm birth increased by 0.1 percentage points [95% CI: -0.2, 0.3]). Increasing Medicaid eligibility alone may be insufficient to improve pre-pregnancy or pregnancy health and birth outcomes. Preconception programming in combination with attention to other structural determinants of pregnancy health is needed.