Association Between Medicaid Expansion And Closure Of Hospital-Based Obstetric Services

Caitlin Carroll, Julia D Interrante, Jamie R. Daw, Katy Backes Kozhimannil

Research output: Contribution to journalArticlepeer-review


Access to obstetric services has declined steadily during the past decade, driven by the closure of hospital-based obstetric units and of entire hospitals. A fundamental challenge to maintaining obstetric services is that they are frequently unprofitable for hospitals to operate, threatening hospital viability. Medicaid expansion has emerged as a possible remedy for obstetric service closure because it reduces uncompensated care and improves hospital finances. Using national hospital data from the period 2010-18, we assessed the relationship between Medicaid expansion and obstetric service closure in rural and urban communities. We found that expansion led to a large reduction in hospital closures; however, this effect was concentrated among hospitals that did not have obstetric units. Considering closure of obstetric units, we found that rural obstetric units were less likely to close immediately after expansion, but this effect faded within two years. Overall, our findings suggest that Medicaid expansion had little effect on the closure of obstetric services. Policies supporting access to obstetric care may need to directly address the financial challenges specific to this service line.

Original languageEnglish (US)
Pages (from-to)531-539
Number of pages9
JournalHealth affairs (Project Hope)
Issue number4
StatePublished - Apr 1 2022

Bibliographical note

Funding Information:
This work is funded by FEDER funds through the COMPETE 2020 Programme and National Funds through FCT ? Portuguese Foundation for Science and Technology under the project number POCI-01-0145-FEDER-007688 (Reference UID/CTM/50025), project PTDC/CTM-BIO/6178/2014 and, the contract LAQV, REQUIMTE- UID/QUI/50006/2013. This work is also supported by Portuguese Science and Technology Foundation through grants SFRH/BPD/64330/2009 and SFRH/BPD/101041/2014 and through project ?Coopera??o Cient?fica e Tecnol?gica? FCT/CAPES ? 2014/2015 (FCT Proc? CAPES).


  • Female
  • Health Facility Closure
  • Hospitals
  • Humans
  • Medicaid
  • Pregnancy
  • Uncompensated Care
  • United States

PubMed: MeSH publication types

  • Journal Article


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