A new report from the Urban Institute indicates that health insurance coverage among new mothers in the first year postpartum has improved significantly over recent years, but that progress has begun to stall.
Using data from the Census Bureau’s American Community Survey (ACS), the researchers find that the uninsured rate among women ages 19 to 44 who had given birth in the prior year declined by 23% between 2019 and 2023 thanks in large part to expansions of Medicaid/CHIP and increased Marketplace coverage, but this improvement did not continue in 2024, the most recent year of data available. And despite some narrowing of gaps, stubborn disparities remain, with higher uninsured rates among new mothers living in non-expansion states, American Indian/Alaska Native (AIAN) and Hispanic new mothers, new mothers below 200% of the federal poverty level, and noncitizen new mothers.
These findings set the stage as researchers, advocates, states, and other stakeholders begin monitoring the impacts of cuts and policies associated with HR 1 and enrollees start feeling the impact. Although enrollees who are pregnant or eligible for postpartum Medicaid/CHIP are excluded from Medicaid work reporting requirements and not subject to more-frequent eligibility checks imposed by H.R. 1, their coverage and access to care is still at risk due to the complex ways pregnant women access Medicaid coverage and system-wide changes states are under tight deadline pressure to put in place. For example, an earlier Urban Institute report found that more than 100,000 pregnant and postpartum women may be enrolled in Medicaid through the expansion category rather than a pregnancy pathway, which could mistakenly leave them subject to work reporting requirements or more frequent eligibility checks and vulnerable to improper disenrollment if their pregnancy or postpartum status is not known to the state agency in a timely way to process the WRR exclusion. The expiration of Marketplace enhanced premium tax credits and restrictions on state-directed payments and provider taxes in Medicaid are also expected to lead to coverage losses and higher uncompensated care costs and lower revenues for hospitals and other providers, which in turn would increase risks of hospital closures and provider shortages and reductions in access to care for all new parents.
Insurance coverage provides a critical first step towards ensuring that new mothers have access to needed care, particularly as women in the US continue to experience too-high rates of death and significant complications associated with pregnancy and childbirth. Evidence shows that stable coverage during the postpartum period increases the chances that mothers attend a postpartum visit, receive mental health treatment, and have more primary care visits, and that it can help protect against the stress and financial hardship associated with high medical costs.
Read more key findings from the report below:
- In 2024, 9.2% of new mothers nationwide—about 347,000 women—were uninsured. This rate varied widely by state, ranging from 2.2% in Massachusetts to 21.1% in Texas.
- The uninsured rate among new mothers declined from 11.7% in 2019 to 9.0% in 2023. However, the rate increased slightly (though not by a statistically significant margin) from 2023 to 2024.
- Increases in Medicaid/CHIP and nongroup coverage drove improvements in the uninsured rate. Between 2019 and 2023, Medicaid/CHIP coverage increased from 28.1% to 30.8% of new mothers as 9 states adopted the ACA’s Medicaid expansion to cover all low-income adults, 41 states and DC adopted a new option to extend postpartum Medicaid coverage from just 60 days to 12 months (all states except Arkansas have now adopted the extension), and the continuous coverage requirement enacted during the pandemic helped eligible individuals maintain their coverage; as states began unwinding this provision during the second half of 2023 and into 2024, Medicaid coverage declined to 29.6%. Nongroup coverage (including Marketplace coverage) increased from 4.7% to 5.4% of new mothers during the same period; the estimated increase to 5.8% in 2024 was not statistically different from the share in 2023.
- Recent expansion states and non-expansion states saw the biggest coverage gains, but non-expansion states still lag behind. The 9 states (Idaho, Maine, Missouri, Nebraska, North Carolina, Oklahoma, South Dakota, Utah, and Virginia) that expanded between 2019 and 2024 saw uninsured rates drop for new mothers from 14.1% to 9.1%, while uninsurance fell from 19.4% to 15.3% in non-expansion states. Still, new mothers in non-expansion states were nearly 2.5 times more likely to be uninsured compared to those in states that had expanded before 2019 (15.3% vs. 6.2% in 2024).
- Coverage gaps narrowed, but some new mothers are still more likely to be uninsured than others, including persistent racial and ethnic disparities tied to relative economic disadvantage. Despite large coverage gains between 2019 and 2024 that helped narrow gaps compared to other groups, American Indian and Alaska Native (19.6%) and Hispanic (18.9%) new mothers had uninsured rates at least twice as high as other groups; the uninsured rate for new mothers in families making less than 200 percent of the federal poverty level was nearly twice as high compared to those making more (15.4% vs. 8.0%); and the uninsured rate among noncitizen new mothers was more than 3.5 times higher than among citizens (25.2% vs. 6.9%).