Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women
Association of Medicaid Expansion With Coverage and Access to Care for Pregnant Women
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DOI：
10.1097/aog.0000000000003501
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发表时间：
2019-11-01
影响因子：
7.2
通讯作者：
Daw, Jamie R.
中科院分区：
文献类型：
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作者：
Clapp, Mark A.;James, Kaitlyn E.;Daw, Jamie R.
目的：确定《平价医疗法案》扩大医疗补助与分娩支付、早期获得产前护理、早产以及小于胎龄的出生体重(SGA)之间的关联。方法：采用差异差异设计，以非扩大状态为对照组，评估扩大状态下医疗补助扩大前后结局的变化。我们使用了2009至2017年的全国出生证明数据。差异线性概率模型被用来评估政策实施的效果，并根据人口统计、出生月份、州、年和县级失业率进行了调整。标准误差集中在州一级。结果：研究样本包括来自15个扩张州的8,701,889名女性和来自11个非扩张州的9,509,994名女性。在调整后的分析中，与非扩张状态相比，扩张状态下医疗补助覆盖的分娩百分比增加了2.3个绝对百分点(95%CI 0.2-4.4，P=0.04)。没有保险的妇女比例没有显著变化，因为私人保险覆盖的分娩百分比相对下降(-2.8个百分点[95%CI-4.9至-0.8，P=0.01])。在医疗补助扩大后，在怀孕前三个月开始产前护理的妇女比率、早产率或低出生体重率也没有显著差异。这两个亚组的研究结果是相似的。结论：医疗补助计划的扩大与扩大州分娩的医疗补助覆盖率增加有关；在非扩大州的私人覆盖率也有类似的增长。早期获得产前护理、早产或SGA出生体重的变化与此无关。
OBJECTIVE: To identify the association of the Affordable Care Act's Medicaid expansion with payment for delivery, early access to prenatal care, preterm birth, and birth weights considered small for gestational age (SGA).METHODS: A difference-in-difference design was used to assess changes in outcomes before and after Medicaid expansion in expansion states, using nonexpansion states as a control group. We used national birth certificate data from 2009 to 2017. Difference-in-difference linear probability models were used to assess the effects of the policy implementation, adjusting for demographics, month of birth, state, year, and county-level unemployment rates. Standard errors were clustered at the state level. Two prespecified subgroup analyses were performed of nulliparous women and women with no more than a high school diploma.RESULTS: The study sample included 8,701,889 women from 15 expansion states and 9,509,994 from 11 nonexpansion states. In the adjusted analysis, the percentage of Medicaid-covered deliveries increased by 2.3 absolute percentage points (95% CI 0.2-4.4, P=.04) in expansion states compared with nonexpansion states. There were no significant changes in the proportion of women who were uninsured, as there was a relative decrease in the percentage of deliveries covered by private insurance (-2.8 percentage points [95% CI -4.9 to -0.8, P=.01]). There were also no significant differences in the rate of women initiating prenatal care in the first trimester, preterm birth rates, or rates of low birth weight after the Medicaid expansion. Findings were similar in both subgroups.CONCLUSION; Medicaid expansion was associated with increased Medicaid coverage for childbirth in expansion states; similar gains in private coverage were seen in nonexpansion states. There were no associations with changes in early access to prenatal care, preterm birth, or SGA birth weights.