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)
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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|Association between state Medicaid expansion through the Affordable Care Act and self-reported pre-conception health care among low-income mothers (2012-2015) ()||2018-04-25 12:20:56 -0400||