Medicaid Expansion Linked to Lower Maternal Mortality Rates

While progress in maternal mortality has been made in much of the developed world, the United States lags behind its peers, with one of the highest maternal mortality rates. Rates of maternal mortality have doubled from 1987 to 2014, with non-Hispanic black women and women living in poverty being impacted at much higher rates.

In addition to maternal mortality as a whole needing drastic improvement, these socioeconomic disparities must be addressed in the process. Providing insight and implications for these disparities, a study presented at the AcademyHealth 2019 National Health Policy Conference, held February 4-5 in Washington, DC, has found that the adoption of Medicaid expansion under the Affordable Care Act (ACA) has been linked to lower rates of maternal mortality.

The study drew upon Underlying Cause of Death data files from 1999 to 2016 from the National Center for Health Statistics. Deaths due to obstetrical tetanus, maternal deaths up to 42 days following delivery, and late maternal deaths were included in the analysis. Conducting a staggered difference-in-difference analysis, the researchers compared maternal mortality rates in states that implemented Medicaid expansion with states that did not expand Medicaid.

“Research shows that women uninsured prior to pregnancy have a higher prevalence of preconception health risk factors as well as lower prevalence of health-promoting indicators,” wrote the researchers. “Increased access to Medicaid coverage prior to pregnancy could improve women’s preconception risk factors, such as obesity, diabetes, and heart disease, which likely contribute to maternal mortality and improve timeliness of prenatal care and access to a greater breadth of covered services.”

Confirming the hypothesis, the researchers observed that Medicaid expansion was significantly associated with lower rates of maternal mortality by 0.16 relative to states that did not expand, reflecting 1.6 fewer maternal deaths per 100,000 women.

Looking at racial and ethnic subgroups, the biggest differences were seen among Hispanic mothers, with 0.22 fewer maternal deaths per 100,000 women in expansion states. However, this effect was not significant among non-Hispanic white or non-Hispanic black or African American mothers.

The researchers also found that in states with uninsured populations of women age 18 to 44 above the 2009 median (pre-ACA), there were 1.9 fewer maternal deaths per 100,000 women, “providing more evidence that the reduction in maternal mortality could be driven by women of reproductive age gaining insurance under the ACA Medicaid expansions.”