Medicaid expansion linked to increased prenatal care in Oregon
Three years after Oregon implemented Medicaid expansion in 2014, the proportion of women in the state who initiated prenatal care in their first trimester had increased by 1.5 percentage points, data published in Preventive Medicine showed.
“The observed increase in prenatal care timeliness and adequacy following Medicaid expansion has important implications for clinical practice,” S. Marie Harvey, DrPH, MPH, associate dean for research at Oregon State University, told Healio.
“Prenatal care visits allow health care providers to monitor crucial aspects of maternal and fetal health,” Harvey said. “Early provision of health care during pregnancy also enhances access to education and needed treatment for issues identified during prenatal care visits, including smoking, alcohol consumption, nutrition, exercise, psychological needs or infant care.”
Harvey and colleagues compared 118,391 deliveries in Oregon occurring before Jan. 1, 2014 — the date that Medicaid expansion was implemented — with 99,938 deliveries occurring after expansion. They found that prior to 2014, 81.8% of women in the state reported initiating prenatal care in their first trimester compared with 83.3% after expansion.
Before the Medicaid expansion, 43.6% of Oregon women with live births were ever enrolled in Medicaid during their pregnancy. Following the expansion, the amount of women rose to 45.1%. Those who were uninsured at the time of delivery decreased from 2.2% to 1.8%.
Likewise, 78.8% of women reported adequate prenatal care in their first trimester before the expansion compared with the 79.8% of women reporting this after the expansion. Pre-pregnancy Medicaid enrollment increased from 18.6% before the expansion, to 34.2% following it. For those ever on Medicaid during pregnancy, enrollment increased from 34.7% to 62.4%.
“Early enrollment in health care, access to care prior to pregnancy, and increased access to preconception and prenatal align with the ‘life course perspective’ on health care,” Harvey said. “This longitudinal pattern of access to care recognizes the importance of the preconception period in promoting maternal health and subsequent neonatal and child health outcomes.”
According to Harvey, because the findings in the study solely reflect Oregon’s experience with Medicaid, the data may not be generalizable at a national level because of demographics, population health, political climate and Medicaid management.
“Our study does, however, build on previous studies and provide evidence that expanding Medicaid coverage has positive effects, including increasing access to early and adequate prenatal care, which could lead to important long-term impacts on childhood and later life health outcomes,” she said. “These positive findings suggest that states that have not expanded their Medicaid programs might improve access to care and health outcomes among low-income populations by extending insurance coverage to low-income adults.”