New Research Links Medicaid Expansion to Lower Maternal Mortality

According to a new study by a CSSW doctoral candidate, a major part of the Affordable Care Act—the expansion of Medicaid—may be linked to lower rates of women dying in pregnancy, childbirth or within six weeks of delivery.

Update: In November 2020, Women’s Health Issues, the official publication of the Jacobs Institute of Women’s Health, awarded Erica Eliason its Charles E. Gibbs Leadership Prize for the paper discussed in this article.

The United States has the worst maternal mortality rate (MMR) in the developed world, and it doubled between 1987 and 2014. This dismal MMR reveals socioeconomic and racial fault lines in the health care system, with non-Hispanic Black women being the most affected.

But hope may be on the horizon in states that are implementing the expansion of Medicaid, according to the findings of CSSW doctoral student Erica Eliason. She recently published an article in Women’s Health Issues suggesting that expansion of Medicaid, which financed 43 percent of the nation’s births in 2017, can be a factor in lowering the rate of maternal deaths.

Analyzing the data can be a challenge, Eliason observes, because pregnancy-related Medicaid eligibility requirements vary from state to state, and states capture maternal death data through different instruments. But according to the data she collected from 2006 to 2017, states that implemented Medicaid expansion were significantly associated with lower rates of maternal death—by about 7 deaths per 100,000 live births—relative to states that did not expand.

Commenting on her findings in CNN Health, Eliason said: “The largest reduction was among non-Hispanic black women, which I think is particularly significant because they have such a higher maternal mortality rate than Hispanic or non-Hispanic white women. So the fact that it’s having the largest effect among that group could mean that it’s reducing the disparities in maternal mortality as well.”

In the introduction to her article, Eliason accounts for her findings as follows:

Increased access to Medicaid coverage before pregnancy could improve women’s health risk factors, such as obesity, diabetes, and heart disease, which can often contribute to maternal mortality; improve timeliness of prenatal care and access to a greater breadth of covered services for pregnancy care; and improve insurance for women past 60 days postpartum, increasing access to sustained insurance coverage during the period of late maternal deaths.

Significantly, a 2019 study by the Centers for Disease Control found that, although nearly 31% of maternal deaths happen during pregnancy and another 36% occur during delivery or the week after, a full third of deaths happen up to a year after a woman gives birth. Medicaid coverage typically is offered to women for up to 60 days after delivery, as Eliason mentions. The American College of Obstetricians and Gynecologists supports extending coverage for women to one year after childbirth, a cause that has been taken up by the House Energy and Commerce Committee. Last November, it advanced new legislation to offer incentives to states to continue Medicaid coverage for women for one year after delivery, to help new mothers who are struggling with such risk factors as cardiovascular disease, postpartum depression, or opioid use.

Concerning these developments, Eliason told CNN Health that the extension of Medicaid coverage for women up to one year postpartum is an area of research she hopes to focus on next. “Women are losing coverage 60 days after childbirth and that is not enough health insurance access for women who recently gave birth,” she said. “I’m really hoping my study can make a difference.”

Eliason is pursuing a PhD in Social Policy Analysis and Economics under the supervision of Associate Professor Heidi Allen and is an affilate of the Columbia Population Research Center. She holds a MPH in Health Policy Analysis from Columbia.