A new report written by my colleagues Edwin Park, Allie Corcoran and I for the Commonwealth Fund examines and summarizes the growing body of research documenting the long-term benefits of Medicaid eligibility for pregnant women and children. Because Medicaid/CHIP expansions were phased in over time, and states reacted on different timetables to federal options and requirements, researchers have been able to compare children in states who were eligible for Medicaid versus those who did not have the same public coverage opportunities. And researchers can track their trajectory over time as those children became adults.
As the number of uninsured children is on the rise and the U.S. continues to be the only developed country with a rising maternal mortality rate, the report underscores how shortsighted it is not to ensure access to continuous, affordable, and comprehensive public coverage to children and pregnant women.
While the immediate benefits of having health insurance are clear (protection from medical debt, better access to primary and preventive care, etc.), the longer-term benefits are less well known. There has been lots of carefully done, new research on this question over the past few years. The studies summarized in the report look specifically at the impact of expanding Medicaid eligibility for children and for pregnant women and infants (i.e. newborns are deemed eligible until age 1 if their parent’s pregnancy was covered by Medicaid).
The research shows a wide range of positive effects ranging from long-term health benefits, educational attainment, and economic outcomes – and even reduced mortality. Some of these positive outcomes were more pronounced for Black children. Please check out the report to see all of the interesting findings! I will highlight a few here:
Long-term health benefits: A number of studies find that early life Medicaid coverage and coverage of pregnant women is associated with fewer chronic conditions such as high blood pressure, heart disease, obesity, and diabetes and healthier birthweights for babies. The benefits carryover even into the next generation. One study finds that for adults (age 19-36), scores on a composite index of health conditions including high blood pressure, diabetes, heart conditions, and obesity improved with increased Medicaid eligibility as children. One study found that in particular, more years of childhood eligibility for Black children led to decreased hospitalizations at age 25. A study published earlier this year found that childhood Medicaid even reduced mortality for young adults.
Educational achievement: A number of studies find that Medicaid eligibility for pregnant women and children is associated with a greater likelihood of graduation from high school (and on time) and a decrease in the high school dropout rate, particularly among children of color. Some studies find higher rates of college attendance and graduation.
Economic impacts/Government ROI: Medicaid coverage of pregnant women and children produces many financial benefits for both individuals and society at large. There are many studies that look at this question from different angles; here are a few examples:
- Early childhood Medicaid coverage reduced application rates for disability benefits (SSI and SSDI) among adults;
- Women with more years of childhood Medicaid eligibility had higher wage income as young adults and paid more in taxes. (See Figure 1)
- Another study found that more than half of the cost of Medicaid coverage in childhood was offset by higher tax receipts in early adulthood.
For more key findings and links to all of the cited research, be sure to read the whole paper!
Because Medicaid is a federal-state matching program, states that make cuts see a distinctly larger “multiplier” effect of these cuts in their health care economy. This is especially true now as the federal matching rate is enhanced by 6.2 percentage points due to the Families First COVID response package.
For a state like California, which has a relatively low federal matching rate, a $1 state cut results in an overall cut of $2.28. In a state like Mississippi, which has the highest federal matching rate, a $1 cut in state Medicaid expenditures results in a total loss of $6.23 to the state’s health care economy. You can see the impact of a state Medicaid budget cut in your state here.
At a time when Medicaid is an important first responder to the pandemic, and children, especially families of color, are facing numerous challenges, undermining access to Medicaid would have extraordinarily damaging short- and long-term consequences.