Effects of Medicaid expansions on infant health among Native Americans

医疗补助扩张对美国原住民（NA）出生结果的影响正在研究之中。 自20世纪80年代初以来，有两个时期的医疗补助资格显着扩大 不同国家在不同时期采用的标准。在20世纪80年代末和90年代， 各州在不同程度上提高了孕妇的医疗补助收入门槛。2014年 后来，根据《平价医疗法案》，许多州扩大了医疗补助的门槛， 收入的成年人。虽然第一个时期可能主要是增加了孕妇获得 产前护理，后期扩展可能进一步增加妇女获得 孕前护理NA母亲的低出生体重率（<2，500 gm），早产率 分娩（妊娠< 37周）和巨大儿（出生体重> 4，500克）。这些差距， 反映了NA社区贫困和慢性病发病率的上升，根源在于 结构性种族主义和历史创伤。医疗补助是健康的重要来源 截至2018年，NAs的保险覆盖了67%的新生儿。因此，医疗补助的扩张 大幅度改善NA孕产妇和婴儿健康的潜力。然而，女性也 在获得护理和将护理转化为改善婴儿健康方面可能面临障碍 健康特别是，社区经济和卫生保健资源的异质性，以及 由于靠近印度卫生服务，可能会影响医疗补助如何影响新生儿出生结果。 这项拟议中的工作利用了来自美国出生证明的国家级微观数据， 出生结果的多个测量（即，出生体重、胎龄、胎儿生长率，以及 APGAR评分），捕获胎儿发育和婴儿健康的不同方面。的 美国社区调查也被用来评估保险范围的趋势。识别 在两个时期（1989-1997年和2010-2018年）， 该项目旨在：（1）估计医疗补助扩张对新生儿出生结局的影响 母亲，测试是否影响不同的NA母亲相对于母亲从其他种族- （2）评估医疗补助是否对婴儿健康有不同的影响， （3）对母亲居住的县的属性;和（3）估计的影响 医疗补助与出生结果有关的合理机制，特别是保险覆盖范围， 产前护理、怀孕期间吸烟和体重增加以及孕产妇健康风险因素 孕期由于出生时的健康塑造了整个生命的福祉和经济成果， 当然，更深入地了解医疗补助如何影响NA孕产妇和婴儿的健康， 可能对改善未来健康和经济状况的长期目标至关重要 一代又一代的NA。

The effects of Medicaid expansions on Native American (NA) birth outcomes are understudied. Since the early 1980's, there have been two periods of notable expansions in Medicaid eligibility criteria that have been adopted by different states at varying times. In the late 1980s and 1990s, states increased Medicaid income thresholds for pregnant women to varying degrees. In 2014 and later, under the Affordable Care Act, many states expanded Medicaid thresholds for low- income adults. While the first period primarily may have increased pregnant women's access to prenatal care, the later period of expansion potentially has further increased women's access to pre-conception care. NA mothers have elevated rates of low birth weight (<2,500 gm), preterm birth (gestation < 37 weeks), and macrosomia (birth weight > 4,500 gm). These disparities, reflecting elevated rates of poverty and chronic disease in NA communities, are rooted in systems of structural racism and historical trauma. Medicaid is an important source of health insurance for NAs, covering 67% of NA births as of 2018. As such, Medicaid expansions have the potential to substantially improve NA maternal and infant health. However, NA women also may face barriers to accessing care and to having that care translate into improved infant health. In particular, heterogeneity in communities' economic and health care resources, as well as proximity to Indian Health Services, may influence how Medicaid impacts NA birth outcomes. The proposed work draws on national-level microdata from U.S. birth certificates and employs multiple measures of birth outcomes (i.e., birthweight, gestational age, fetal growth rates, and APGAR scores), capturing distinct aspects of fetal development and infant health. The American Community Survey is also used to assess trends in insurance coverage. Identifying plausibly exogenous Medicaid expansions in two periods (1989-1997 and 2010-2018), this project aims to: (1) Estimate the effects of Medicaid expansions on birth outcomes among NA mothers, testing whether effects differ for NA mothers relative to mothers from other racial- ethnic groups; (2) Evaluate whether Medicaid has differing impacts on infant health depending on the attributes of the counties in which mothers reside; and; (3) Estimate the effects of Medicaid on plausible mechanisms linked to birth outcomes, specifically, insurance coverage, prenatal care, smoking and weight gain during pregnancy, and maternal health risk factors during pregnancy. As health at birth shapes wellbeing and economic outcomes across the life course, a deeper understanding of how Medicaid influences NA maternal and infant health is likely critical to longer-term goals of improving health and economic conditions for future generations of NAs.