Medicaid Expansion Improves Key Prenatal, Postpartum Indicators

Poor maternal and infant care access can have deadly implications for new mothers and their babies, but Medicaid expansion efforts can improve three key prenatal and postpartum health indicators, a recent study published in Health Affairs found.

“We evaluated whether increased access to health insurance under the Affordable Care Act Medicaid expansions affected ten preconception health indicators,” the report began.

The study focused on ten measures recommended by the National Preconception Health and Health Care Initiative and the Centers for Disease Control and Prevention (CDC). The measures included observing changes in chronic conditions, behaviors, contraception use, and other factors.

The study worked with data from two CDC surveys, one survey ranging from 2011 through 2018 and the other from 2012 to 2017. To identify changes in care for Medicaid expansion beneficiaries, the researchers compared current data to the baseline mean of pre-expansion data.

Demographically, low-income women in non-expansion states tended to be younger than their counterparts in expansion states and were less likely to be of Hispanic descent.

Medicaid expansion increased preconception coverage by 11.5 percentage points and postpartum coverage by 8.5 percentage points. However, the researchers noted that the uninsurance rate did not appear to be significantly affected by these increases.

Non-pregnant women of reproductive age saw no significant shifts in the health indicators in Medicaid expansion states.

However, low-income women in Medicaid expansion states who had just given birth saw improvement over their baseline in three quality measures: a preconception health consultation, daily prenatal folic acid intake, and use of contraception in the postpartum timeframe.

Specifically, the share of women who said that they engaged in a preconception conversation with their healthcare provider before becoming pregnant rose by four percentage points. This represented a 22 percent increase compared to the baseline mean pre-expansion.

Preconception conversations typically cover risks related to elements such as smoking and depression during pregnancy.

“This is important because it is estimated that half of pregnancies in the United States are affected by chronic health and behavioral risk factors that increase the risk for adverse maternal and infant outcomes and for which effective preconception medical interventions exist,” the researchers noted.

The share of women who stated they were taking folic acid in the month prior to pregnancy went up 9.7 percent over the states’ baseline means pre-expansion, or 1.9 percentage points.

Folic acid intake is critical to protect against certain defects, meaning that this nearly 10 percent increase in folic acid consumption among low-income women can lead to better health outcomes for their infants.

Lastly, the share of women who reported using contraception in the postpartum period rose 7.1 percent over the baseline.

Postpartum contraceptive usage can help reduce unplanned pregnancies and brief inter-pregnancy intervals.

Despite these increases, certain chronic diseases and other health behaviors did not see improvements under Medicaid expansion.

The researchers acknowledged that there may be other factors not included in the study that contributed to the shifts. There could also be discrepancies in participant Medicaid eligibility due to the way that the surveys calculated incomes. Self-report or recall bias could also have an impact on the study outcomes.

Also, the ability to evaluate participant experience based on additional factors such as race or health status as well as the ability to compare with states that did not participate in the surveys were limited.

Even with these limitations and results, the researchers considered the findings around prenatal and postpartum care as significant.

“Even if coverage does not change the prevalence of risky health conditions in the short term, it can improve the uptake of proper treatment and management of these conditions, which may also have important implications for maternal and infant health,” the researchers stated.

“In sum, ACA Medicaid expansions—a public policy still under active debate in many states— can help address some of the risk factors that shape maternal and child health in the United States.”

Recent studies have found Medicaid expansion a successful tool on a couple of healthcare fronts for women. For example, Medicaid expansion increased women’s likelihood to access long-acting, reversible contraception and more stable postpartum healthcare coverage.

Medicaid expansion states also have more policies around Medicaid eligibility for immigrants, a population that is likely to be uninsured.