The central goal of our parent R01 project, Policy Change and Women's Health (HDR01095951), is to examine the impact of Medicaid expansion, particularly under the Affordable Care Act (ACA), on preconception health, reproductive health behavior (e.g., contraception, unintended pregnancy, and fertility), and pregnancy health and outcomes. With this Supplement request, we propose to extend our inquiry to address the impact of Medicaid expansion on pregnancy-associated mortality and its determinants in the postpartum period. Prior to the ACA Medicaid expansions, many low-income women who qualified for Medicaid during pregnancy lacked health insurance coverage prior to conception and subsequently lost coverage 60 days after delivery. This discontinuity of insurance across the perinatal period may be a key determinant in pregnancy-associated mortality. The expansion of Medicaid to low income women regardless of pregnancy status offers an opportunity to examine whether increasing continuity of insurance prior to and after pregnancy improves postpartum health care utilization, mental health, and rates of pregnancy-associated mortality. Thus, we will extend Aim 1 of our Parent R01, which assesses the impact of Medicaid expansion on preconception health care utilization, health behavior, and health using Pregnancy Risk Monitoring System (PRAMS) 2012-2017 data to also assess postpartum continuity of insurance, health care utilization, and mental health. We will extend Aim 3 of our Parent R01, which examines the impact of Medicaid expansion on pregnancy health and outcomes using vital statistics data, to assess overall and cause-specific pregnancy-related mortality. Moreover, we will examine racial/ethnic inequities in the impact of Medicaid expansion on both determinants of and rates in pregnancy-associated mortality. Achieving these aims will expand research on one of the potential leading causes of pregnancy-associated mortality in the U.S.: discontinuous insurance during the perinatal period, particularly the cessation of Medicaid eligibility after 60 days postpartum. We will also identify how policy-level determinants impact racial/ethnic disparities in risk factors for and rates of pregnancy-associated mortality in the U.S.
This research will advance public health and policy knowledge about the impacts of Medicaid expansion on determinants and rates of, and disparities in, pregnancy-associated mortality. Our findings will provide policy- relevant information about whether extending Medicaid coverage across the perinatal period improves measures of postpartum health and reduces pregnancy-associated mortality.
