ACA Improved Health Care Access and Affordability for New Mothers, Report Finds

We often get asked whether increases in health coverage rates result in more people getting care. In the case of new mothers following the implementation of the ACA’s major coverage provisions in 2014, a recent report from the Urban Institute shows the answer for this group is yes.

In the years following the 2014 coverage expansions, new mothers were less likely to report unmet medical care or prescription medication needs, and more likely to have seen a general doctor and received a flu shot than in the years before the coverage expansions took effect.

While barriers remain for new mothers to access health care–particularly because pregnancy Medicaid coverage ends just 60 days postpartum–the report findings suggest that the ACA likely contributed to improvements in health care access and affordability for new mothers, and that future coverage expansions could help even more.

The report, which is based on data from the National Health Interview Survey (NHIS), defines “new mother” as women ages 19 to 44 with an infant (younger than age 1) whose NHIS record indicates they are the child’s biological or adoptive mother. Because of sample size, the study periods are the years before and after the major 2014 ACA coverage expansions (2011-2013 and 2015-2018, respectively.)

During these time ranges, the uninsured rate for new mothers dropped dramatically, from about 20.2 percent in 2011 to 11.3 percent in 2015, and remained steady in the following years through 2018. This translated to new mothers being about 60 percent less likely to have unmet needs for prescription drugs and specialist care after the ACA’s coverage provisions took effect in 2014, the authors found. The report findings also build on the evidence that when states expand Medicaid, more people seek preventive care and avoid preventable complications from diseases such as diabetes and hypertension. A recent study showed that the ACA’s Medicaid expansion closed coverage gaps for pregnant women too.

However, the positive results for new mothers were not distributed equally, the report found. Black and Hispanic new mothers still have higher uninsured rates than their white peers, face greater risks of maternal mortality and morbidity, and are less likely to receive postpartum care. The authors also pointed to social barriers, such as lack of transportation, child care, family leave, and the specific barrier of racism for Black women that keep them from accessing quality health care. Future coverage expansions should be designed to reduce inequities for Black and Hispanic women, the authors recommend.

The findings add momentum to the growing effort to extend Medicaid coverage to one year postpartum. A House bill passed last week would give states the option to extend pregnant Medicaid to one year postpartum and receive federal matching funds. Currently, states can only receive federal matching funds to extend postpartum coverage beyond 60 days through a Section 1115 waiver.

Three states (Illinois, New Jersey, Missouri) have applied for some version of a postpartum coverage extension waiver, but no state has been approved by CMS. Even more states – more than 20 – are on a path to do the same. Still other states, notably California and Texas, are using state-only funds to offer more limited benefits to a subset of postpartum women.

The report findings suggest that should the coverage extensions be approved, and more effort put into outreach for enrolling women already eligible, more new mothers would access the care they need.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.