Reducing Postpartum Health Care Disparities through Increased Insurance Coverage after Childbirth

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PROJECT SUMMARY Dr. Steenland’s long-term career goal is to become an independent policy researcher generating evidence to improve maternal health in the US. African American women are more likely than white women to experience severe maternal morbidity and mortality. As Medicaid covers a disproportionally large share of African American and Hispanic women during pregnancy, the program plays a critical role in their maternal health. However, many women covered by Medicaid during pregnancy lose coverage at 60 days postpartum. US policy makers are considering policy options to reduce disparities in maternal mortality, including extending Medicaid pregnancy coverage from 60 days to one year postpartum. However, the effect of increased Medicaid coverage on postpartum health care use and health outcomes is not known. Dr. Steenland will examine the role of Medicaid expansion on disparities in postpartum insurance coverage, health care access, and health outcomes among recently pregnant women. She will use data from the American Community Survey and the Arkansas All-Payers Claims Database to pursue the following research aims: (1) Evaluate the effect of Medicaid expansion on racial/ethnic disparities in postpartum insurance coverage nationally; (2) Examine the effect of Medicaid expansion on disparities in postpartum care and health outcomes between African American and non-Hispanic white women in Arkansas, the state with the largest gains in postpartum insurance coverage after Medicaid expansion. These studies will provide much needed evidence to US policy makers about the effect of increased postpartum insurance coverage on health care utilization and outcomes. The proposed research builds upon Dr. Steenland’s prior research on the effects of Medicaid reimbursement for immediate postpartum long-acting reversible contraception on postpartum contraceptive use and birth intervals. She will pursue the following K01 training aims to prepare her for the proposed research and for her career goals: (1) Acquire training in obstetrics and maternal health; (2) Acquire training in domestic health policy; (3) Acquire advanced training in econometric methods for health policy evaluation. To achieve these training goals, Dr. Steenland has assembled a team of mentors at Brown University, led by Dr. Amal Trivedi, Professor in the School of Public Health’s Department of Health Services, Policy, and Practice; Dr. Ira Wilson, Professor and Chair of the Department of Health Services, Policy, and Practice; Dr. David Savitz, Professor in the Department of Epidemiology in the School of Public Health; Dr. Kristen Matteson, Associate Professor of Obstetrics and Gynecology in the Department of Obstetrics and Gynecology and Dr. Anna Aizer, Professor and Chair of the Department of Economics. Dr. Steenland’s training will prepare her to achieve her long-term career goal of becoming an independent investigator working to reduce disparities and improve maternal health through health policy research.