Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality |
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| Institution: | 1. Ibis Reproductive Health, Cambridge, Massachusetts;2. Office of Population Research, Princeton University, Princeton University, Princeton, New Jersey;3. Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California;1. University of Arkansas for Medical Sciences, Little Rock, Arkansas;2. Institute for Medicaid Innovation, Washington, District of Columbia;3. University of Michigan Medical School, Department of Obstetrics & Gynecology, Ann Arbor, Michigan;1. Emory University Nell Hodgson Woodruff School of Nursing, Emory University School of Medicine, Atlanta, Georgia;2. Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia;3. Medical Mutual of Ohio, Cleveland, Ohio;1. Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia;2. Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia;1. Columbia University School of Social Work, New York, New York;2. Boston University School of Public Health, Boston, Massachusetts |
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| Abstract: | ObjectivesThis study explores the effect of Medicaid expansion under the Affordable Care Act on the maternal mortality ratio in the United States.MethodsA difference-in-differences research design was used to analyze the effect of Medicaid expansion on maternal mortality. Maternal mortality was defined with and without late maternal deaths, to substantiate the contribution of increased preconception and postpartum insurance coverage. To examine whether there was a racial difference in the effects of Medicaid expansion, models were stratified by the woman's race/ethnicity for non-Hispanic Black women, non-Hispanic White women, and Hispanic women.ResultsMedicaid expansion was significantly associated with lower maternal mortality by 7.01 maternal deaths per 100,000 live births (p = .002) relative to nonexpansion states. When maternal mortality definitions excluded late maternal deaths, Medicaid expansion was significantly associated with a decrease in maternal mortality per 100,000 live births by 6.65 (p = .004) relative to nonexpansion states. Medicaid expansion effects were concentrated among non-Hispanic Black mothers, suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.ConclusionsAlthough maternal mortality overall continues to increase in the United States, the maternal mortality ratio among Medicaid expansion states has increased much less compared with nonexpansion states. These results suggest that Medicaid expansion could be contributing to a relative decrease in the maternal mortality ratio in the United States. The decrease in the maternal mortality ratio is greater when maternal mortality estimates include late maternal deaths, suggesting that sustained insurance coverage after childbirth as well as improved preconception coverage could be contributing to decreasing maternal mortality. |
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