Medicaid Expansion Fills Gaps in Maternal Health Coverage Leading to Healthier Mothers and Babies

Top Lines

  • Research shows #Medicaid expansion is associated with a reduction in maternal and infant mortality.

In This Report:

Key Findings

  • New research shows states that expand Medicaid improve the health of women of childbearing age: increasing access to preventive care, reducing adverse health outcomes before, during and after pregnancies, and reducing maternal mortality rates.
  • While more must be done, Medicaid expansion is an important means of addressing persistent racial disparities in maternal health and maternal mortality.
  • Better health for women of childbearing age also means better health for their infants. States that have expanded Medicaid under the Affordable Care Act saw a 50 percent greater reduction in infant mortality than non-expansion states.
  • The uninsured rate for women of childbearing age is nearly twice as high in states that have not expanded Medicaid compared to those that have expanded Medicaid (16 percent v. 9 percent). States with the highest uninsured rates for women of childbearing age are: Alabama, Alaska, Florida, Georgia, Idaho, Mississippi, Nevada, North Carolina, Oklahoma, South Carolina, Texas and Wyoming. Ten of these twelve states have not expanded Medicaid.


Disruptions in health coverage are associated with adverse health consequences.1 This is especially true for women in their childbearing years, when a pregnancy means having health coverage is even more important. The stakes are high as the care a woman receives during pregnancy is critical to her own health, as well as to the health of her newborn. In the United States, maternal and infant mortality is higher than most other industrialized nations,2 lending urgency to strategies to address the overall health of women.3

In this paper we review the substantial new research showing the significant improvements in access to health coverage for women of childbearing age achieved through the adoption of the Affordable Care Act’s (ACA) Medicaid expansion. Better health coverage is important not just for women who are pregnant but also for women well before they become pregnant and well after childbirth. The American College of Obstetricians and Gynecologists (ACOG) recommends women have access to continuous health coverage in order to increase preventive care, reduce avoidable adverse obstetric and gynecologic health outcomes, increase early diagnosis of disease and reduce maternal mortality rates.4 Research also finds that Medicaid expansion has an important role in reducing the significant and persistent racial disparities in maternal and infant health. And finally, new studies show that healthier mothers mean healthier infants— another benefit for states that expand Medicaid.

Percentage Point Decline in the Uninsured Rate for Women of Childbearing Age (18-44), 2013-2017

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  1. B.D. Sommers et al., “Insurance Churning Rates For LowIncome Adults Under Health Reform: Lower Than Expected But Still Harmful For Many,” Health Affairs 35, no. 10 (October 2016), available at
  2. M.F. MacDorman et al., “International Comparisons of Infant
    Mortality and Related Factors: United States and Europe, 2010,” National Vital Statistics Reports 63, no. 5, (September 2014), available at
  3. M.F. MacDorman et al., “Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues,” Obstetrics & Gynecology, 128 vol. 3 (September 2016): 447–455, available at PMC5001799/.
  4. American College of Obstetricians and Gynecologists, “Benefits
    to Women of Medicaid Expansion Through the Affordable Care Act” (Washington: American College of Obstetricians and Gynecologists, January 2013), available at