Association between state Medicaid expansion through the Affordable Care Act and self-reported pre-conception health care among low-income mothers (2012-2015) Open Access

Amiling, Raiza (Spring 2018)

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     The Affordable Care Act (ACA) was passed in 2010 and expanded Medicaid to all those with household incomes 138 percent below the federal poverty level. A ruling by the U.S. Supreme Court gave states the option of expanding the program, resulting in a coverage gap of uninsured low-income individuals that do not meet traditional Medicaid requirements and do not qualify for tax credits to buy insurance in marketplaces. For low-income women of reproductive age, this poses a challenge in accessing and utilizing pre-conception health care, services to improve health and decrease risk factors that may affect future pregnancies. This study seeks to understand the impact of expansion on the utilization of pre-conception health services by low-income women.


     The difference-in-difference framework was utilized to analyze data from the Pregnancy Risk Assessment Monitoring System from 2012-2015. 26 sites were analyzed, utilizing questions about pre-conception care, income, and insurance. Prevalence of pre-conception care for pre-expansion versus post-expansion periods and non-expansion versus expansion sites were calculated. Variables in the adjusted model included year, maternal age, maternal race/ethnicity, maternal education, and income.


     Non-expansion sites had an increase of 1.1 percent (SE: 1.18) in pre-conception care visits, while expansion sites had a 1.7 percent (SE: 0.90) increase. While there was a smaller increase in pre-conception care visits among non-expansion sites versus expansion sites, it was not statistically significant (DD estimate: -0.01, p-value: 0.54). Non-expansion sites had a decrease of 3.3 percent (SE: 1.45) in uninsurance and a 0.7 percent (SE: 1.55) increase in Medicaid enrollment, while expansion sites had a 10.6 percent (SE: 0.96) decrease in uninsurance and an 11.3 percent (SE: 1.13) increase in Medicaid enrollment.


     Although not statistically significant, this study showed there was an increase in pre-conception care visits among non-expansion and expansion sites, with a smaller increase among non-expansion sites.

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