Effects of Medicaid expansions on infant health among Native Americans

医疗补助的扩大对美洲原住民(NA)出生结果的影响还没有得到充分的研究。 自20世纪80年代初S以来，医疗补助资格经历了两个显著的扩张时期 不同的州在不同的时间采用的标准。20世纪80年代末和90年代， 各州不同程度地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》，许多州扩大了低收入家庭的医疗补助门槛。 有收入的成年人。虽然第一个阶段主要可能增加了孕妇获得 产前护理，后期的扩大有可能进一步增加妇女获得 孕前护理。NA母亲有较高的低出生体重率(&lt；2500克)，早产 出生(妊娠37周)和巨大儿(出生体重和GT；4,500克)。这些差异， 反映出北美社区的贫困率和慢性病比率上升，根源于 结构性种族主义和历史创伤的制度。医疗补助是健康的重要来源 NAS保险，截至2018年覆盖67%的NA出生。因此，医疗补助计划的扩大已经 大幅改善北非孕产妇和婴儿健康的潜力。然而，娜娜女人也 可能会面临获得护理和将这种护理转化为改善婴儿的障碍 健康。特别是，社区经济和保健资源的异质性也是如此 由于靠近印度医疗服务，可能会影响医疗补助如何影响新生儿的出生结果。 这项拟议的工作借鉴了来自美国出生证明的国家级微观数据，并雇用了 出生结果的多种衡量标准(例如，出生体重、胎龄、胎儿生长率和 阿普加评分)，捕捉胎儿发育和婴儿健康的不同方面。这个 美国社区调查也被用来评估保险覆盖面的趋势。识别 看似外生的医疗补助计划在两个时期(-1997年和2010年-2018年)扩大，这 该项目的目标是：(1)评估扩大医疗补助对北美新生儿出生结局的影响 母亲，测试相对于其他种族的母亲，NA母亲的影响是否不同 评估医疗补助对婴儿健康是否有不同的影响 关于母亲居住的县的属性；以及；(3)估计 关于与生育结果有关的合理机制的医疗补助，特别是保险覆盖， 产前护理、孕期吸烟和体重增加，以及产妇健康风险因素 在怀孕期间。因为出生时的健康决定着一生的幸福和经济结果 当然，更深入地了解医疗补助如何影响北美的母婴健康是 可能对改善未来健康和经济状况的长期目标至关重要 一代代的NAS。

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.