Impacts of the Affordable Care Act's Medicaid Expansion on Live Births.
Impacts of the Affordable Care Act's Medicaid Expansion on Live Births.
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DOI：
10.1097/ede.0000000000001462
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发表时间：
2022-05-01
期刊：
影响因子：
5.4
通讯作者：
Margerison, Claire E.
中科院分区：
文献类型：
--
作者：
Gartner, Danielle R.;Kaestner, Robert;Margerison, Claire E.
我们假设，《平价医疗法案》（ACA）的医疗补助扩大，将健康保险覆盖范围扩大到符合收入资格准则的妇女的孕前、孕间和孕后时期，通过增加获得避孕和经济福利的机会，影响了美国的活产数量。这些影响可能因产妇的社会经济和人口特征而异。使用汇总到州年水平的出生证明数据和差异中的差异设计，我们估计了医疗补助扩张和活产数之间的关系。我们还研究了社会经济和人口统计学特征是否存在关联差异。总体而言，医疗补助扩大与出生数无显著相关（差异中的差异=0.002,95% CI: - 0.010, 0.015）。然而，在某些群体中，医疗补助扩张与活产数的有意义变化有关，尽管所有置信区间都包括零值。在18-24岁的人群中，医疗补助扩大与活产数之间的关系估计为- 0.025 (95% CI: - 0.052, 0.001)；已婚者为- 0.078 (95% CI: - 0.231, 0.075)，未婚者为- 0.035 （95% CI: - 0.104, 0.034）。尽管它有可能影响活产，但我们的研究结果表明，ACA的医疗补助扩张通常与美国育龄居民的活产无关。然而，对于年轻女性、已婚女性和未婚女性来说，估计的幅度支持了医疗补助扩大对活产可能产生有意义影响的假设。
We hypothesize that the Affordable Care Act’s (ACA) Medicaid expansion, which extended health insurance coverage to pre-conception, between-conception, and post-conception periods for women meeting income eligibility guidelines, impacted the number of live births in the US, by increasing access to contraception and financial wellbeing. These impacts may differ by maternal socioeconomic and demographic characteristics. Using data from birth certificates aggregated to the state–year level and a difference-in-differences design, we estimated the association between Medicaid expansion and count of live births. We also examined whether associations differed by socioeconomic and demographic characteristics. Overall, Medicaid expansion was not meaningfully associated with the count of births (difference-in-differences ß=0.002, 95% CI: −0.010, 0.015). However, among certain groups, Medicaid expansion was associated with meaningful changes in the count of live births, though all confidence intervals included the null value. The estimate of the relationship between Medicaid expansion and the count of live births was −0.025 (95% CI: −0.052, 0.001) for those ages 18-24 years; −0.078 (95% CI: −0.231, 0.075) for those who were married and −0.035 (95% CI: −0.104, 0.034) for those who were unmarried. Despite its potential to impact live births, our results indicate that the ACA’s Medicaid expansion was not, in general, associated with live births of US residents of reproductive age. However, for younger, married and unmarried women, the magnitude of estimates supports the hypothesis of a potentially meaningful effect of Medicaid expansions on live births.