The Impact of Including Pregnancy as a Qualifying Life Event for Marketplace Special Enrollment on Child and Maternal Health

项目总结/摘要 及时、高质量的产前护理与改善儿童和孕产妇健康结果相关， 怀孕期间全面的健康保险有助于获得产前护理。保障性 《保健法》将产前和产妇保健列为10项基本保健福利之一， 市场计划中涵盖的（即，个人商业保险计划）。ACA市场是一个 对于没有资格获得医疗补助或雇主的孕妇来说，这是一个重要的健康保险来源- 赞助保险。然而，当前的Marketplace注册政策使得注册成为一项挑战。 a在怀孕早期实施市场计划，这可能对获得产前检查产生不利影响。 保健以及儿童和孕产妇健康成果。 所有市场计划都有一个年度开放注册期（OEP），从大约11月到 一月个人只能通过特殊的 登记期（SEP），其是合格生活事件之后的有限时间窗口（例如，保险损失 覆盖范围或家庭变化[包括分娩]）。ACA没有将怀孕列为资格 SEP Marketplace覆盖范围。因此，在OEP之外怀孕的人必须 延迟市场注册，直到他们有一个合格的SEP资格的事件，下一个年度OEP，或给 出生近年来，美国有六个州颁布了政策，将怀孕列为SEP市场。 资格活动，这意味着这些州的人们可以在成为 怀孕了我们假设，这项政策有助于在怀孕早期进行市场登记，增加 市场上接受及时，高质量产前护理的孕妇的百分比，并改善 市场参与者的孕产妇和婴儿健康结果。 我们的研究将利用州一级市场SEP资格变化所创建的自然实验 评估将怀孕作为SEP合格事件的政策影响的规则。具体来说，我们将 第一（目标1）描述市场在提供健康保险覆盖和获得 孕妇产前护理（目标1）。然后，我们将使用稳健的准实验设计来评估 将妊娠作为SEP合格事件对（目标2）及时产前护理和（目标3）婴儿的影响 以及参加Marketplace的孕妇的孕产妇健康结果。我们将使用所有付款人索赔数据 从纽约（干预州）和马萨诸塞州（控制州），从2014年至2019年，这提供了许多 与之前在市场上对孕妇进行的研究中使用的数据相比具有优势。我们的调查结果显示， 研究将为州一级和联邦一级决策者提供关键和及时的信息， 市场保险（i）适用于没有其他保险选择的孕妇，以及（ii） 有效改善产前护理，并最终改善儿童和孕产妇健康结果。

Project Summary/Abstract Timely, high-quality prenatal care is associated with improved child and maternal health outcomes, and comprehensive health insurance coverage during pregnancy facilitates access to prenatal care. The Affordable Care Act (ACA) included prenatal and maternity care as one of the ten essential health benefits that must be covered in Marketplace plans (i.e., commercial insurance plans for individuals). ACA Marketplaces are an important source of health insurance for pregnant people who are not eligible for Medicaid or employer- sponsored insurance. However, current Marketplace enrollment policies make it challenging to enroll in a Marketplace plan early in pregnancy, which may have adverse consequences for access to prenatal care and child and maternal health outcomes. All Marketplace plans have an annual open enrollment period (OEP) from approximately November to January. An individual can enroll in a Marketplace plan outside of the annual OEP only through a special enrollment period (SEP), which is a limited time window after a qualifying life event (e.g., loss of insurance coverage, or household change [including childbirth]). The ACA did not include pregnancy as a qualifying event for SEP Marketplace coverage. Therefore, people who become pregnant outside of the OEP must delay Marketplace enrollment until they have an eligible SEP-qualifying event, the next annual OEP, or give birth. In recent years, six U.S. states have enacted policy to include pregnancy as a Marketplace SEP- qualifying event, meaning that people in these states can enroll in a Marketplace plan when they become pregnant. We hypothesize that this policy facilitates Marketplace enrollment earlier in pregnancy, increases the percent of pregnant people on the Marketplace who receive timely, high-quality prenatal care, and improves maternal and infant health outcomes for Marketplace enrollees. Our study will exploit a natural experiment created by state-level variation in Marketplace SEP eligibility rules to estimate the impact of a policy to include pregnancy as a SEP-qualifying event. Specifically, we will first (Aim 1) describe the role of the Marketplace in providing health insurance coverage and access to prenatal care for pregnant people (Aim 1). We will then use a robust quasi-experimental design to evaluate the impact of including pregnancy as an SEP-qualifying event on (Aim 2) timely prenatal care and (Aim 3) infant and maternal health outcomes for pregnant people who enroll in Marketplace. We will use all-payer claims data from New York (intervention state) and Massachusetts (control state) from 2014-2019, which provide many advantages over data used in prior research of pregnant people on the Marketplace. The findings from our study will provide critical and timely information for state-level and federal-level policy-makers to ensure that Marketplace coverage is (i) accessible for pregnant people without other insurance coverage options, and (ii) effective in improving prenatal care and, ultimately, child and maternal health outcomes.