TY - JOUR
T1 - Impact of Medicaid Expansion on Interpregnancy Interval
AU - Liu, Can
AU - Snowden, Jonathan M.
AU - Rossin-Slater, Maya
AU - Torche, Florencia
AU - DiTosto, Julia D.
AU - Carmichael, Suzan L.
N1 - Funding Information:
Funding Statement: This work was supported by funding from Stanford Maternal and Child Health Research Institute , United States.
Publisher Copyright:
© 2021 The Author(s)
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Objectives: Medicaid expansion under the Affordable Care Act (ACA) improved access to reproductive health care for low-income women and birthing people who were previously ineligible for Medicaid. We aimed to evaluate if the expansion affected the risk of having a short interpregnancy interval (IPI), a preventable risk factor for adverse pregnancy outcomes. Methods: We evaluated parous singleton births to mothers aged 19 or older from U.S. birth certificate data 2009–2018. We estimated the effect of residing in a state that expanded Medicaid access (expansion status determined at 60 days after the prior live birth) on the risk of having a short IPI (<12 months) using difference-in-differences (DID) methods in linear probability models. We stratified the analyses by maternal characteristics and county-level reproductive health care access. Results: Overall risk of short IPI was 14.9% in expansion states and 16.3% in non-expansion states. The expansion was not associated with a significant change in risk of having a short IPI (adjusted mean percentage point change 1.24 [-1.64, 4.12]). Stratified results also did not provide support for an association. Conclusions: ACA Medicaid expansion did not have an impact on risk of short IPI. Preventing short IPI may require more comprehensive policy interventions in addition to health care access.
AB - Objectives: Medicaid expansion under the Affordable Care Act (ACA) improved access to reproductive health care for low-income women and birthing people who were previously ineligible for Medicaid. We aimed to evaluate if the expansion affected the risk of having a short interpregnancy interval (IPI), a preventable risk factor for adverse pregnancy outcomes. Methods: We evaluated parous singleton births to mothers aged 19 or older from U.S. birth certificate data 2009–2018. We estimated the effect of residing in a state that expanded Medicaid access (expansion status determined at 60 days after the prior live birth) on the risk of having a short IPI (<12 months) using difference-in-differences (DID) methods in linear probability models. We stratified the analyses by maternal characteristics and county-level reproductive health care access. Results: Overall risk of short IPI was 14.9% in expansion states and 16.3% in non-expansion states. The expansion was not associated with a significant change in risk of having a short IPI (adjusted mean percentage point change 1.24 [-1.64, 4.12]). Stratified results also did not provide support for an association. Conclusions: ACA Medicaid expansion did not have an impact on risk of short IPI. Preventing short IPI may require more comprehensive policy interventions in addition to health care access.
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U2 - 10.1016/j.whi.2021.12.004
DO - 10.1016/j.whi.2021.12.004
M3 - Article
C2 - 35016841
AN - SCOPUS:85122538912
VL - 32
SP - 226
EP - 234
JO - Women's Health Issues
JF - Women's Health Issues
SN - 1049-3867
IS - 3
ER -