A Healthy Start to Life: How Medicaid Expansion Improves Pregnancy and Birth Outcomes

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Birth outcomes, including infant mortality and low birth weight, are shockingly poor in the U.S. compared with peer countries. The U.S. is also the only industrialized nation with a rising maternal mortality rate, and racial disparities in maternal morbidity and mortality have launched an outcry from advocates and policymakers alike. Yet Medicaid expansion under the Affordable Care Act (ACA) has the potential to improve the health and health behaviors of women of reproductive age, prevent unintended pregnancy, and, as a result, improve birth outcomes.

In this project, the research team will use the Pregnancy Risk Monitoring Survey (PRAMS) data from 2010 to 2017 to assess whether the ACA increased intended pregnancies, reduced prepregnancy smoking, and affected contraception and birth outcomes among women covered by Medicaid. The team will also explore whether these changes reduced disparities across racial and ethnic groups.

Researchers will also examine the health impacts of various Medicaid policy choices prior to implementation of the ACA (e.g., Medicaid eligibility requirements and state family-planning programs), account for states’ early adoption of Medicaid expansion, and assess whether policy choices such as premium levels affect outcomes.

Key staff: Stacy McMorrow, PhD; Emily Johnston, PhD