ACA Medicaid Expansion and Insurance Coverage Among New Mothers Living in Poverty
ACA Medicaid Expansion and Insurance Coverage Among New Mothers Living in Poverty
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DOI：
10.1542/peds.2019-3178
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发表时间：
2020-05-01
期刊：
影响因子：
8
通讯作者：
Kenney, Genevieve M.
中科院分区：
文献类型：
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作者：
Johnston, Emily M.;McMorrow, Stacey;Kenney, Genevieve M.
背景：医疗补助在围产期起着至关重要的作用，但与妊娠相关的医疗补助资格仅延长至产后60天。2014年，《平价医疗法案》（ACA）扩大了医疗补助计划，将参与州的成人医疗补助资格提高到联邦贫困水平的138%，允许符合条件的新妈妈在怀孕相关保险到期后继续享受医疗补助。我们调查了ACA医疗补助扩大对生活在贫困中的新妈妈的保险覆盖范围的影响。方法：我们将生活在贫困中的新妈妈定义为年龄在19岁至44岁之间、收入低于联邦贫困水平、在过去12个月内分娩的女性。我们使用2010-2017年美国社区调查数据和使用父母医疗补助资格阈值的差异中之差方法来估计ACA医疗补助扩大对贫困新妈妈保险覆盖范围的影响。结果：父母医疗补助资格每增加100个百分点，贫困新妈妈的无保险率下降8.8个百分点（P < 0.001），医疗补助覆盖率增加13.2个百分点（P < 0.001），私人或其他保险覆盖率下降4.4个百分点（P = 0.001）。医疗补助资格的平均增加与未参保人数减少28%、医疗补助覆盖范围增加13%以及在扩张州的贫困新妈妈中私人或其他保险下降18%相关。然而，在2017年，仍有大约14.2万名没有保险的贫困新妈妈。结论：ACA医疗补助计划的扩大与医疗补助覆盖面的增加和贫困新妈妈无保险的减少有关。扩张州和非扩张州仍有机会为生活贫困的新妈妈增加保险覆盖范围。在这项研究中，我们使用差异中的差异方法估计了ACA医疗补助扩大对最近分娩的贫困妇女的保险覆盖范围的影响。
BACKGROUND: Medicaid plays a critical role during the perinatal period, but pregnancy-related Medicaid eligibility only extends for 60 days post partum. In 2014, the Affordable Care Act's (ACA's) Medicaid expansions increased adult Medicaid eligibility to 138% of the federal poverty level in participating states, allowing eligible new mothers to remain covered after pregnancy-related coverage expires. We investigate the impact of ACA Medicaid expansions on insurance coverage among new mothers living in poverty. METHODS: We define new mothers living in poverty as women ages 19 to 44 with incomes below the federal poverty level who report giving birth in the past 12 months. We use 2010-2017 American Community Survey data and a difference-in-differences approach using parental Medicaid-eligibility thresholds to estimate the effect of ACA Medicaid expansions on insurance coverage among poor new mothers. RESULTS: A 100-percentage-point increase in parental Medicaid-eligibility is associated with an 8.8-percentage-point decrease (P < .001) in uninsurance, a 13.2-percentage-point increase (P < .001) in Medicaid coverage, and a 4.4-percentage-point decrease in private or other coverage (P = .001) among poor new mothers. The average increase in Medicaid eligibility is associated with a 28% decrease in uninsurance, a 13% increase in Medicaid coverage, and an 18% decline in private or other insurance among poor new mothers in expansion states. However, in 2017, there were similar to 142 000 remaining uninsured, poor new mothers. CONCLUSIONS: ACA Medicaid expansions are associated with increased Medicaid coverage and reduced uninsurance among poor new mothers. Opportunities remain for expansion and nonexpansion states to increase insurance coverage among new mothers living in poverty.In this study, we estimate the effects of ACA Medicaid expansions on insurance coverage among women living in poverty who recently gave birth using a difference-in-differences approach.