Affordable Care Act shifted childbirth coverage to private insurance

Post by IU Newsroom intern Annie Brackemyre

In a research letter to the New England Journal of Medicine, Indiana University researchers show that the young-adult provision in the Affordable Care Act led to a decrease in Medicaid coverage of childbirth among women ages 19 to 26.

Authors of the letter, titled Dependent Coverage under the ACA and Medicaid Coverage for Childbirth,” include Yaa Akosa Antwi, professor of economics at IUPUI; Jie Ma, a Ph.D. student in the IU Bloomington Economics Department; Kosali Simon, professor in the School of Public and Environmental Affairs at IU Bloomington; and Aaron Carroll, professor in the IU School of Medicine.

Woman in labor

National Institutes of Health photo

Until the health care law passed in 2010, Medicaid covered birthing costs for women earning less than 133 percent of the federal poverty level, roughly half of all births in the U.S. Childbirth services have traditionally been financed differently than other health care services.

The new IU research looks at the effect on Medicaid’s childbirth financing of the young adult provision in the health care law, an allowance for children and dependents to remain on their parents’ insurance until they are 26 years old.

“In a set of prior research projects that we published, we had investigated the effects of the young adult provision on insurance coverage for all young adults and their use of health care services,” said Simon. “This made us think about the kinds of health care services that young adults use. They are generally healthy and don’t use hospital care much, for example. But there is a pretty high rate of hospital use among young adults for one specific reason, and that is childbirth.”

Using data from the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality, the authors looked for impacts on payment sources for childbirth. The study compared these ‘young’ mothers – age 26 and under — against a control population of mothers ages 27-29, who were ineligible to receive insurance benefits from their parents.

Findings show that the young adult provision led to a 2.5 percentage point increase in private-insurance reimbursement, a 10 percent increase from the baseline, and notably impacted unmarried mothers. The findings suggest a significant shift in financing childbirth from Medicaid coverage to private insurance in mothers ages 19 to 26.

“There are many changes in financing of care that are happening right now, because of the ACA,” said Simon. “It will take a long time and much research to understand the full ramifications of all those changes, and this is one example of a specific service, childbirth, for a specific population, young adults. There will be many more research studies understanding effects of the ACA as we as a nation address health care access and financing through public policy.”

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