Insurance churn, or moving between different insurance plans or between insurance and uninsurance, is common during the perinatal period. We used survey data from the 2012–17 Pregnancy Risk Assessment Monitoring System to estimate the impact of Affordable Care Act–related state Medicaid expansions on continuity of insurance coverage for low-income women across three time points: preconception, delivery, and postpartum. We found that Medicaid expansion resulted in a 10.1-percentage-point decrease in churning between insurance and uninsurance, representing a 28 percent decrease from the prepolicy baseline in expansion states. This decrease was driven by a 5.8-percentage-point increase in the proportion of women who were continuously insured and a 4.2-percentage-point increase in churning between Medicaid and private insurance. Medicaid expansion improved insurance continuity in the perinatal period for low-income women, which may improve the quality of perinatal health care, but it also increased churning between public and private health insurance.
Bibliographical noteFunding Information:
This study was supported by a grant awarded to Lindsay Admon (principal investigator), Tyler Winkelman (co investigator), and Vanessa Dalton (co investigator) from the Health Resources and Services Administration, Department of Health and Human Services, as part of an award totaling $100,000. The contents of the manuscript are those of the authors and do not necessarily represent the official views of, nor an endorsement by, the Health Resources and Services Administration, the Department of Health and Human Services, or the federal government. Jamie Daw’s work on this project was supported by a Calderone Junior Faculty Prize. The funders had no role in the study design, writing of the report, or the decision to submit the article for publication. Dalton was a paid, expert witness for Bayer and a consultant for Bind. The other authors have no conflicts of interest to report. The authors thank all Pregnancy Risk Assessment Monitoring System study participants and members of the Pregnancy Risk Assessment Monitoring System Working Group.
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