Administrative Supplement to Policy Change and Women's Health

项目摘要 我们的母项目R 01“政策变化和妇女健康”（HDR 01095951）的中心目标是审查 医疗补助扩张的影响，特别是根据《平价医疗法案》（ACA），对孕前健康的影响， 生殖健康行为（例如，避孕、意外怀孕和生育）和妊娠健康 和结果。通过本补充请求，我们建议扩大调查范围，以解决以下问题的影响： 医疗补助扩大对妊娠相关死亡率及其在产后期间的决定因素。之前 ACA医疗补助扩张，许多在怀孕期间有资格获得医疗补助的低收入妇女缺乏 在怀孕前获得健康保险，随后在分娩后60天失去保险。这 围产期保险的不连续性可能是妊娠相关疾病的一个关键决定因素， mortality.将医疗补助扩大到低收入妇女，无论怀孕状况如何， 有机会审查增加怀孕前后保险的连续性是否会改善 产后保健利用率、心理健康和妊娠相关死亡率。因此，我们将 扩展我们的父R 01的目标1，评估医疗补助扩展对孕前健康的影响 2012-2017年使用妊娠风险监测系统（PRAMS）的护理利用、健康行为和健康 数据也评估产后保险的连续性，医疗保健利用率和心理健康。我们将 扩展我们的父R 01的目标3，该目标检查了医疗补助扩展对妊娠健康的影响， 使用生命统计数据评估总体和具体原因导致的妊娠相关死亡率。 此外，我们将研究医疗补助扩张对两个决定因素的影响中的种族/民族不平等， 以及与怀孕有关的死亡率。实现这些目标将扩大对一种潜在的 美国妊娠相关死亡率的主要原因：围产期不连续保险 特别是产后60天后停止医疗补助资格。我们还将确定如何 政策一级的决定因素影响种族/族裔差异的风险因素和比率的怀孕有关的 美国的死亡率

PROJECT SUMMARY The central goal of our parent R01 project, Policy Change and Women's Health (HDR01095951), is to examine the impact of Medicaid expansion, particularly under the Affordable Care Act (ACA), on preconception health, reproductive health behavior (e.g., contraception, unintended pregnancy, and fertility), and pregnancy health and outcomes. With this Supplement request, we propose to extend our inquiry to address the impact of Medicaid expansion on pregnancy-associated mortality and its determinants in the postpartum period. Prior to the ACA Medicaid expansions, many low-income women who qualified for Medicaid during pregnancy lacked health insurance coverage prior to conception and subsequently lost coverage 60 days after delivery. This discontinuity of insurance across the perinatal period may be a key determinant in pregnancy-associated mortality. The expansion of Medicaid to low income women regardless of pregnancy status offers an opportunity to examine whether increasing continuity of insurance prior to and after pregnancy improves postpartum health care utilization, mental health, and rates of pregnancy-associated mortality. Thus, we will extend Aim 1 of our Parent R01, which assesses the impact of Medicaid expansion on preconception health care utilization, health behavior, and health using Pregnancy Risk Monitoring System (PRAMS) 2012-2017 data to also assess postpartum continuity of insurance, health care utilization, and mental health. We will extend Aim 3 of our Parent R01, which examines the impact of Medicaid expansion on pregnancy health and outcomes using vital statistics data, to assess overall and cause-specific pregnancy-related mortality. Moreover, we will examine racial/ethnic inequities in the impact of Medicaid expansion on both determinants of and rates in pregnancy-associated mortality. Achieving these aims will expand research on one of the potential leading causes of pregnancy-associated mortality in the U.S.: discontinuous insurance during the perinatal period, particularly the cessation of Medicaid eligibility after 60 days postpartum. We will also identify how policy-level determinants impact racial/ethnic disparities in risk factors for and rates of pregnancy-associated mortality in the U.S.