Administrative Supplement to Policy Change and Women's Health

项目总结 我们的母公司R01项目，政策变化和妇女健康(HDR01095951)的中心目标是检查 扩大医疗补助，特别是根据《平价医疗法案》(ACA)，对先入为主的健康的影响， 生殖健康行为(例如，避孕、意外怀孕和生育)和怀孕健康 和结果。通过这项补充请求，我们建议扩大我们的调查范围，以解决以下影响 扩大医疗补助对产后妊娠相关死亡率及其决定因素的影响。在.之前 ACA医疗补助计划的扩大，许多有资格在怀孕期间获得医疗补助的低收入妇女缺乏 怀孕前的医疗保险覆盖范围，随后在分娩后60天后失去覆盖范围。这 围产期保险中断可能是与妊娠相关的一个关键决定因素 死亡率。将医疗补助扩大到低收入妇女，无论怀孕状态如何，提供了 检查怀孕前后保险连续性增加的机会是否有所改善 产后保健利用、心理健康和与妊娠相关的死亡率。因此，我们将 扩展我们父母R01的目标1，该目标评估扩大医疗补助对怀孕前健康的影响 使用妊娠风险监测系统(PRMS)2012-2017年的护理利用、健康行为和健康 数据还评估产后保险的连续性、医疗保健利用情况和精神健康状况。我们会 扩展我们的父母R01的目标3，该目标检查了扩大医疗补助对怀孕健康和 使用生命统计数据评估总体和特定原因的妊娠相关死亡率。 此外，我们将研究扩大医疗补助对以下两个决定因素的影响中的种族/民族不平等 以及与怀孕相关的死亡率。实现这些目标将扩大对其中一个潜力的研究 美国妊娠相关死亡的主要原因：围产期不连续保险 在此期间，特别是在产后60天后不再有医疗补助资格。我们还将确定如何 政策层面的决定因素影响与怀孕相关的风险因素和妊娠率的种族/民族差异 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.