After the Affordable Care Act, Medicaid Still Pays for Significant Share of Preterm Births

WASHINGTON, DC (June 4, 2020) — Prior to the Affordable Care Act (ACA) insurance coverage expansions, Medicaid paid for a disproportionate share of preterm births in the United States. A study published today finds that after the ACA coverage expansions took effect, the share of preterm births paid for by private insurance increased slightly while Medicaid continued to cover nearly half.

The study was published in Women’s Health Issues, the official journal of the Jacobs Institute of Women’s Health, which is based at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).

Anne Rossier Markus, PhD, MHS, JD, professor and chair of the Department of Health Policy and Management at Milken Institute SPH, and Rose Meltzer, who was a graduate student at Milken Institute SPH when conducting the study, used National Vital Statistics Birth Data to explore payment mix patterns of all births and preterm births in each year from 2011 through 2016. This time span includes three years before and three years after the January 1, 2014 effective date for the ACA’s coverage expansions.

Markus and Meltzer found that the percentage of preterm births covered by private insurance increased from the pre-coverage expansion to the post-coverage expansion period (42.1 percent in 2011 to 43.5 percent in 2016), and the decline was accompanied by a slight decrease in the self-pay or uninsured proportion (4.1 percent in 2011 to 3.8 percent in 2016). Although the proportion of preterm births covered by Medicaid fluctuated slightly from year to year, it was 48.9 percent in both 2011 and 2016.

“Our results confirm the significant size and relative stability of Medicaid as an insurance source for the most vulnerable women in American society, fulfilling its role as a financial safety net that provides access to necessary maternity care,” the authors wrote.

“Women who give birth before 37 weeks tend to face more health risks than those who give birth at full term, and we want to make sure they have insurance coverage so they can access comprehensive care,” Markus explained. “If ongoing efforts to repeal the ACA succeed, we could see more uninsured women in this high-risk population.”

“An Analysis of Payment Mix Patterns of Preterm Births in a Post-Affordable Care Act Insurance Market: Implications for the Medicaid Program” was published online on June 4 as an article in press and will appear in the July/August issue of Women’s Health Issues.