Medicaid expansion linked with fewer postpartum hospitalizations: research

Story at a glance

  • Medicaid expansion states saw lower rates of postpartum hospitalizations compared with those that have not adopted the policy.

  • Just 11 states have not expanded Medicaid under the Affordable Care Act.

  • The new data suggest expanding Medicaid can improve maternal health outcomes among low-income Americans.

States that expanded Medicaid under the Affordable Care Act (ACA) saw a 17 percent drop in hospitalizations among women during the first 60 days postpartum, new research shows.

Medicaid expansion permitted states to cover most adults with incomes up to 138 percent of the Federal Poverty Level, allowing a larger share of low-income individuals to qualify for coverage before pregnancy and after a 60-day postpartum period.

This preconception and postpartum insurance coverage among low-income birthing people led to greater continuity of coverage and use of outpatient care, researchers explained.

Access to health care during pregnancy and the postpartum period are crucial for both new parents and their infants. However, in the United States lack of insurance coverage can prevent many mothers from seeking care and lead to worse health outcomes.

Compared with 10 other developed countries, the United States ranks worst when it comes to maternal mortality, while data show over half of maternal deaths occur in the postpartum period.

The United States is also the only developed country that does not guarantee access to provider home visits or paid maternal leave during this period, according to The Commonwealth Fund.

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To better understand hospitalization rates in the postpartum period, researchers assessed longitudinal hospital data from 2010 to 2017, and compared changes in hospitalizations among individuals with Medicaid-financed delivery in states that did and did not expand Medicaid.

Expansion states included Iowa, Maryland, New Mexico and Washington. Rates were compared with non-expansion states Florida, Georgia, Mississippi, and Utah.

In addition to the 17 percent drop within the first 60 days, data also suggested a smaller decrease in hospitalizations between 61 days and six months postpartum. However, because hospitalizations in this period were so rare, the sample size was too small to draw conclusions, authors said.

“There’s an ongoing conversation by health policy experts about the types of interventions that could improve maternal health in this country,” said study author Laura Wherry, an assistant professor of economics and public service at New York University, in a release.

“Our study looks at that question in the context of expanding access to health insurance through Medicaid.”

The majority of hospitalization declines seen can be attributed to a decrease in child-birth related visits, researchers explained.

“We already know from previous studies that Medicaid expansion increased postpartum health insurance,” added co-author Maria Steenland, an assistant professor of health services, policy and practice at Brown University, in a statement.

Currently, 40 states including Washington D.C. have expanded Medicaid under the ACA. Much of the Southeast region of the country continues to hold out on adoption, along with Texas, Kansas, Wyoming and Wisconsin.

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