Evidence-based reproductive care decreases morbidity and mortality for women and their children, reduces disparities, and saves money; however, many women do not receive needed reproductive care. Cost and lack of health insurance are known barriers to receiving care, and women who are poor and representative of racial and/or ethnic minorities are least likely to receive needed reproductive care. The Affordable Care Act (ACA) prioritized reproductive health care as an essential component of women's clinical preventive services and called for every state to significantly expand Medicaid coverage by 2014. Little is yet known about how ACA Medicaid expansions are impacting the delivery of reproductive health care. The 2012 United States (US) Supreme Court ruling that made ACA Medicaid expansions optional for states created a natural experiment to answer this important question. As of January, 2016, 31 states and the District of Columbia had expanded Medicaid, while 19 states had not. We will use this unprecedented natural experiment to study the impact of the ACA and Medicaid expansion on the provision of women's reproductive health care in community health centers (CHCs). The proposed Reproductive care in the safety net: Women's health after Affordable Care Act implementation (EVERYWOMAN) project is a mixed-methods study that will leverage patient-level electronic health record (EHR) data from two CHC networks: the Community Health Applied Research Network (CHARN) and the ADVANCE clinical data research network (CDRN). Together, the CHARN and ADVANCE research data warehouses have patient-level data on over 3 million patients from CHCs across 26 states (14 expansion and 12 non-expansion states). These data will be augmented through qualitative data on patient and provider perceptions of the impact of the ACA on reproductive health care in low-income and vulnerable populations.
The specific aims are as follows:
Aim 1 : Describe provision of women's reproductive health care before and after implementation of the ACA and between expansion and non-expansion states.
Aim 2 : Identify individual, clinic, and state-level factors associated with provision of women's reproductive health care.
Aim 3 : Understand provider and patient perceptions of the provision and utilization of reproductive health care in low-income and vulnerable populations. This project builds on our team's experience in insurance, primary care, women's health, and utilizing EHR clinical data for research. The ADVANCE and CHARN datasets position us uniquely to study national-level impacts of the ACA. Findings will be relevant to policy and practice, informing efforts to enhance the provision of timely, evidence-based reproductive care, improve health outcomes, and reduce disparities among low- income vulnerable populations of women.
Despite evidence demonstrating that evidence-based reproductive health care decreases morbidity and mortality for women and their children, reduces disparities, and saves money, many women do not receive needed reproductive health care services, and women who are poor and representative of racial and/or ethnic minorities are least likely to receive needed care. By expanding access to Medicaid and prioritizing women's preventive services, including reproductive health care, the Affordable Care Act has the potential to significantly enhance the provision of reproductive health care, especially in low-income and underserved populations served by community health centers. The proposed project is a mixed-methods study that will leverage patient-level electronic health record (EHR) data from two community health center networks [the Community Health Applied Research Network (CHARN) and the ADVANCE clinical data research network], augmented through qualitative data to explore if and how the ACA and Medicaid expansion have impacted the provision and utilization of reproductive health care services in community health center settings.
| Küng, Stephanie A; Darney, Blair G; Saavedra-Avendaño, Biani et al. (2018) Access to abortion under the heath exception: a comparative analysis in three countries. Reprod Health 15:107 |
