Insurance churn, or moving between different insurance plans or between insurance and uninsurance, is common during the perinatal period. The authors 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. Authors 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.

Authors: Jamie R. Daw, Tyler N. A. Winkelman, Vanessa K. Dalton, Katy B. Kozhimannil, and Lindsay K. Admon

Publication Date: September 2020

DOI: https://doi.org/10.1377/hlthaff.2019.01835

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