As we see increasing numbers of pregnant women and newborns being disenrolled from Medicaid, a new study adds to evidence of long-term benefits of Medicaid investments– this time for the grandchildren and children of pregnant women and their newborns. For many years, CCF has highlighted the growing research on the long-term health and educational impacts of investments in Medicaid. A new study in the American Economic Review added to the growing body of evidence documenting a link between Medicaid coverage during children’s earliest stages of development and health outcomes for the next generation of infants. But this time Medicaid coverage during early life stages– even before birth– is linked to improved health outcomes for the next generation.
Multigenerational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation’s Health builds on prior research showing 1) health experiences during the early childhood period can have long-term impacts on health and economic outcomes, and 2) public health interventions focused on children, such as Medicaid eligibility increases, are associated with positive outcomes lasting into adulthood (a finding familiar to regular Say Ahhh! readers). Researchers have also studied possible links between prenatal health experiences and impacts on the following generation. For example, fetal exposure to the Chinese famine during 1959-1961 was associated with an increase in the incidence of low birth weight in the next generation. Another study linked passage of the Civil Rights Act, which mandated desegregation in institutions receiving federal funds, to subsequent improvements in the Black infant mortality rate.
This study built on these areas of research and considered the potential multigenerational benefits of Medicaid. Since Medicaid pays for roughly half of all births in the United States, it is an important resource for ensuring access to high-quality healthcare during the perinatal period and well into adulthood. Like other studies of Medicaid’s long-term impact, the authors used state expansion of Medicaid coverage for pregnant women in the 1980s to compare outcomes among those in states with and without access to coverage during pregnancy. The analysis allowed researchers to link in utero Medicaid health coverage with second generation data. Centers for Disease Control and Prevention’s 1975-2017 U.S. Vital Statistics Reports provided birth records, demographic information about mothers, and health outcomes for their infants.The researchers examined a variety of birth outcomes for the children of people whose mothers were covered during pregnancy, including the incidence of low birth weight and preterm birth. (See here for a more in-depth look at the methodology of this study.)
In sum, children born to women who benefited from Medicaid pregnancy expansions were more likely to have children with better birth outcomes than those born to pregnant women without Medicaid. This illustrates the important role of Medicaid in addressing health equity from generation to generation, given its potential to close health and economic gaps between historically advantaged and disadvantaged groups.
States are actively seeking to improve maternal and early childhood health, yet we keep seeing postpartum women and newborns being dropped for procedural reasons. Maternal and early childhood health changes, such as doulas or improved access to mental health, only help pregnant women and newborns if they have coverage to begin with. Keeping pregnant women and newborns from being disenrolled unnecessarily should be a top priority.
Editor’s note: To maintain accuracy, Georgetown CCF uses the term “women” when referencing statute, regulations, research, or other data sources that use the term “women” to define or count people who are pregnant or give birth. Where possible, we use more inclusive terms in recognition that not all individuals who become pregnant and give birth identify as women.