Reducing Racial and Ethnic Disparities in Maternal Health through Policy Interventions

拟议的研究项目的长期目标是改善少数民族的健康， 减少在严重孕产妇发病率和孕产妇死亡率方面的种族和族裔差异， mortality.具体而言，拟议的研究项目将评估3个重要健康 扩大保险政策，减少严重孕产妇发病率方面的种族和族裔差异 (SMM)1）2010年《患者保护和平价医疗法》下的家属保险条款 (ACA)要求私人医疗保险公司允许年轻人在26岁之前继续使用父母的计划 生日; 2）2014年ACA医疗补助扩展，使各州可以选择将医疗补助覆盖范围扩大到非 收入不超过联邦贫困线138%的老年人;以及3） 2020年家庭首次冠状病毒应对法案（FFCRA）暂时维持医疗补助覆盖范围 60-产后30天内，只要COVID-19公共卫生紧急状态到位。 少数种族和民族生育的人比非西班牙裔白色人的可能性高出三倍 在分娩和产后期间体验SMM。解决SMM中的种族和族裔差异 被认为是一个紧迫的公共卫生优先事项。SMM是指意外的严重分娩并发症 与分娩有关，并与产妇死亡风险大幅增加有关。提供持续健康 建议通过健康政策提供保险，从怀孕前到产后1年， 采取干预措施，缩小这些差距。多达80%的少数民族和种族生育的人没有 这样的持续覆盖。然而，有证据表明，健康保险政策的变化与种族歧视的减少有关。 SMM中的种族差异很小。2010年ACA家属保险条款，2014年ACA 医疗补助扩张和2020年FFCRA维持努力提出了三个自然实验， 评估扩大医疗保险覆盖面在减少种族和民族差异方面的有效性， SMM。拟议的项目将测试一系列与具体目标有关的假设，包括： 26岁以下的人获得私人医疗保险与种族和民族 SMM的差异; 2）扩大低收入人群的医疗补助覆盖范围与减少种族歧视有关 SMM中的种族差异，以及3）将低收入人群的医疗补助覆盖范围从60天扩大到1天， 产后1年与产后SMM的种族和民族差异减少有关。国家和 来自医疗保健研究和质量机构医疗保健成本和利用项目的国家数据将 使用稳健的准实验方法进行分析，例如差异中的差异。 该项目的结果将有助于缩小健康差距研究的重要差距，并提供 为政策干预提供有力证据，以减少种族和族裔健康差距， 生孩子它符合美国国立卫生研究院的IMPROVE倡议的目标。

The long-term goal of the proposed research project is to improve the health of minoritized racial and ethnic birthing people by reducing racial and ethnic disparities in severe maternal morbidity and maternal mortality. Specifically, the proposed research project will assess the effectiveness of 3 significant health insurance expansion policies in reducing racial and ethnic disparities in severe maternal morbidity (SMM): 1) the 2010 Dependent Coverage Provision under the Patient Protection and Affordable Care Act (ACA), requiring private health insurers to allow young adults to remain on their parent’s plan until their 26th birthday; 2) the 2014 ACA Medicaid expansion, giving states the option to expand Medicaid coverage to non- elderly adults with incomes up to 138% of the Federal Poverty Level; and 3) the Maintenance of Effort of the 2020 Families First Coronavirus Response Act (FFCRA) temporarily maintaining Medicaid coverage beyond 60-days postpartum as long the COVID-19 Public Health Emergency is in place. Minoritized racial and ethnic birthing people are three times more likely than non-Hispanic White people to experience SMM during childbirth and the postpartum. Addressing racial and ethnic disparities in SMM is recognized as an urgent public health priority. SMM refers to unintended serious complications of labor and delivery and is associated with substantially increased risk of maternal death. Providing continuous health insurance coverage through health policies, from preconception to 1-year postpartum, is a suggested intervention to mitigate these disparities. Up to 80% of minoritized racial and ethnic birthing people do not have such continuous coverage. However, evidence linking health insurance policy changes to reduced racial and ethnic disparities in SMM is scant. The 2010 ACA Dependent Coverage Provision, the 2014 ACA Medicaid expansion, and the 2020 FFCRA Maintenance of Effort present three natural experiments for assessing the effectiveness of expanding health insurance coverage in reducing racial and ethnic disparities in SMM. The proposed project will test a series of hypotheses related to the specific aims, including: 1) Expanded access to private health insurance for people under age 26 is associated with reduced racial and ethnic disparities in SMM; 2) Expanded Medicaid coverage for low-income people is associated with reduced racial and ethnic disparities in SMM, and 3) Extending Medicaid coverage for low-income people from 60-day to 1- year postpartum is associated with reduced racial and ethnic disparities in postpartum SMM. National and state data from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, will be analyzed using robust quasi-experimental approaches such as the difference-in-difference-in-differences. Results of this project will help close important gaps in health disparities research and provide rigorous evidence to inform policy interventions to reduce racial and ethnic health disparities among birthing people. It aligns with the aims of the IMPROVE initiative of the National Institutes of Health.