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

项目摘要/摘要 及时、高质量的产前护理与改善儿童和产妇的健康状况有关，以及 全面的孕期健康保险有助于获得产前护理。买得起的人 《保健法案》(ACA)将产前和产妇护理列为必须提供的十项基本健康福利之一 在市场计划(即，个人商业保险计划)中涵盖。ACA市场是一个 没有资格获得医疗补助或雇主的孕妇的重要医疗保险来源- 赞助保险。然而，当前的Marketplace注册政策使注册变得具有挑战性 怀孕早期的市场计划，这可能会对获得产前机会产生不利影响 护理以及儿童和产妇健康结果。 所有Marketplace计划都有一个年度开放投保期(OEP)，大约从11月到 一月。个人只能通过特殊计划注册年度OEP之外的市场计划 投保期(SEP)，这是在符合资格的人生事件(例如，保险损失)之后的有限时间窗口 覆盖范围，或家庭变化[包括生育])。ACA没有将怀孕作为资格赛 SEP市场报道活动。因此，在OEP之外怀孕的人必须 推迟Marketplace注册，直到他们有合格的SEP资格认证活动、下一年的OEP或 出生。近年来，美国六个州已经制定了政策，将怀孕纳入市场SEP- 资格事件，这意味着这些州的人在达到以下条件时可以注册Marketplace计划 怀孕了。我们假设，这项政策促进了市场在怀孕早期的注册，增加了 市场上接受及时、高质量产前护理并改善的孕妇的百分比 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资格差异所产生的自然实验 评估将怀孕作为SEP资格事件的政策的影响的规则。具体来说，我们将 首先(目标1)描述市场在提供医疗保险覆盖范围和获得医疗保险方面的作用 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 将怀孕列为SEP合格事件对(目标2)及时产前护理和(目标3)婴儿的影响 以及在Marketplace注册的孕妇的孕产妇健康结果。我们将使用所有付款人的索赔数据 来自纽约州(干预州)和马萨诸塞州(控制州)，这两个州提供了许多 与市场上先前对孕妇的研究中使用的数据相比，该数据具有优势。来自我们的调查结果 研究将为州和联邦一级的政策制定者提供关键和及时的信息，以确保 市场覆盖范围是(I)没有其他保险覆盖选择的孕妇可以获得的，以及(Ii) 有效地改善产前护理，并最终改善儿童和产妇的健康结果。

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.