Panel Paper: The Affordable Care Act Medicaid Eligibility Expansions and Pre-Conception Health Care

Friday, November 8, 2019
I.M Pei Tower: Terrace Level, Terrace (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Rebecca Myerson and Sam Crawford, University of Southern California

Maternal and infant mortality are higher in the United States than many other high income countries, and maternal mortality more than doubled in the United States between 2000 and 2014. Improving the health of non-pregnant women during their reproductive years (defined here as age 18–44) is a crucial step toward improving these reproductive health outcomes. The National Pre-conception Health and Health Care Initiative defines low pre-conception health as the presence of risk factors such as diabetes, hypertension, obesity, depression, and smoking, chronic risk factors that increase the risk of serious complications during pregnancy if not managed well prior to conception. However, management of chronic physical and mental health conditions may be challenging without access to health care. The goal of the Affordable Care Act (ACA) was to improve access to insurance and affordable health care, and Medicaid eligibility expansions under the ACA were a key component of these efforts. However, little is known about whether these policies increased access to needed health care for women with low pre-conception health. We analyzed nationally representative data of non-institutionalized adults from the Behavioral Risk Factor Surveillance Survey over 2012-2017, including over 75,000 women of reproductive age with one or more of the above pre-conception health concerns. We used difference-in-differences regression models to calculate the change in insurance coverage and medical care access and affordability associated with Medicaid eligibility expansions, after adjusting for the demographic and socio-economic characteristics of respondents. After Medicaid eligibility expansions, women with low pre-conception health became 4.2 percentage points more likely to have health insurance coverage (95% CI 2.6 to 5.8 percentage points), 5.4 percentage points more likely to have an annual checkup (95% CI 2.6 to 8.1 percentage points), and 3.3 percentage points less likely to forego needed doctor visits due to cost (95% CI 0.8 to 5.8 percentage points). However, only 33% of women of reproductive age with low pre-conception health lived in states that elected to expand Medicaid eligibility under the ACA. In 2017, important gaps in health care coverage, access, and affordability remained: 15% of women with low pre-conception health lacked health insurance, 23% reported skipping needed medical care due to cost, 31% had unpaid medical bills, and 34% had not had a check-up in the past year. In conclusion, despite recent improvements in states that expanded Medicaid access under the ACA, women with low pre-conception health still face significant gaps in health care coverage, access, and affordability. Efforts to further support access to care among women with low pre-conception health should remain a priority for policy-makers as part of the battle against maternal and infant mortality.