Influence of recent Medicaid expansion to legal permanent resident pregnant women

 描述（由申请人提供）：本研究有助于文献研究医疗补助覆盖范围对身体健康和医疗保健利用的影响。我们利用变异， 2009年儿童健康保险计划再授权法案（CHIPRA）提供的医疗补助资格和覆盖范围，该法案将医疗补助覆盖范围扩大到居住在美国的前五年内的法律的永久居民孕妇（LPRPW）。在41个州中，有14个州以前没有使用州专用资金向LPRPW提供医疗保险。我们使用这种政策变化作为一个自然的实验，研究CHIPRA的影响，采用国家相比，非采用国家。我们从我们的分析中删除了9个州，这些州使用州专用资金为LPRPW提供医疗补助。我们将CHIPRA的这一政策变化与2003年至2012年期间美国的所有出生记录相匹配。我们利用幸运的时间在支付源信息被添加到出生记录数据在2009年，前不久在选定的国家实施CHIPRA。我们的第一个模型是一个简化形式的模型，探讨CHIPRA实施对支付来源（即私人保险，医疗补助，或没有保险），产前检查，早产，低出生体重儿，异常出生条件和婴儿死亡率的结果的影响。我们提出了一个差异中的差异分析，比较结果LPRPW居住在实施CHIPRA相对于LPRPW在比较状态的状态。我们的研究结果提供了医疗补助扩大时私人保险的挤出程度的估计，以及CHIPRA如何影响产前检查和出生结果的估计，包括LPRPW在CHIPRA实施之前没有保险的可能性更高。我们的第二个模型是一个工具变量模型，研究医疗补助对产前护理利用和出生结果的影响，利用CHIPRA的医疗补助资格的变化。拟议的研究将为各州决定是否通过ACA和/或CHIPRA扩大其医疗补助计划提供更多信息。拟议的项目还将为申请人继续研究医疗补助扩张如何影响医疗保健利用和健康结果奠定基础。

 DESCRIPTION (provided by applicant): This study contributes to the literature examining the effect of Medicaid coverage on physical health and health care utilization. We exploit variation in Medicaid eligibility and coverage provided by the 2009 Children's Health Insurance Program Reauthorization Act (CHIPRA), which expanded Medicaid coverage to legal permanent resident pregnant women (LPRPW) within their first five years living in the United States. Fourteen of 41 states not previously using state-only funds to provide health insurance to LPRPW enacted CHIPRA. We use this policy variation as a natural experiment, studying the effects of CHIPRA within adopting states compared to non-adopting states. We remove from our analysis 9 states using state-only funds to provide Medicaid coverage to LPRPW. We match this policy variation from CHIPRA onto all birth records in the United States from the period of 2003 to 2012. We exploit fortunate timing in payment source information being added to the birth record data in 2009, shortly before CHIPRA implementation in select states. Our first model is a reduced form model to explore the effect of CHIPRA implementation on outcomes of payment source (i.e. private insurance, Medicaid, or no insurance), prenatal care visits, premature births, low birth weight births, abnormal birth conditions, and infant mortality. We propose a difference- in-differences analysis, comparing outcomes between LPRPW residing in states that implemented CHIPRA relative to LPRPW in comparison states. Our results provide an estimate of the extent of crowd-out of private insurance when Medicaid is expanded, as well as an estimate of how CHIPRA influenced prenatal care visits and birth outcomes, including for LPRPW with a higher probability of being uninsured prior to CHIPRA implementation. Our second model is an instrumental variable model to study the impact that having Medicaid has on prenatal care utilization and birth outcomes, exploiting variation in Medicaid eligibility from CHIPRA. The proposed research will provide additional information to states deciding whether to expand their Medicaid programs through the ACA and/or CHIPRA. The proposed project will also lay a foundation for the applicant to continue studying how Medicaid expansions influence health care utilization and health outcomes.