In the Journals

State Medicaid expansion associated with decline in racial disparities among infants

Photo of Clare Brown 
Clare Brown
Photo of Mick Tilford 
Mick Tilford

States that expanded Medicaid under the Affordable Care Act did not see any significant differences in rates of low birth weight or preterm birth outcomes overall, but there were significant improvements in disparities for black infants, according to research published in JAMA.

“We wanted to see if adverse birth outcomes would be reduced in expansion states relative to nonexpansion states,” Clare Brown, PhD, MPH, instructor in the Fay W. Boozman College of Public Health, said in a press release. “We hypothesized that there would be greater declines among black infants because of the much higher rates of preterm birth and low birth weight among this population.”

Brown and colleagues analyzed U.S. population-based data from the National Center for Health Statistics Birth Data Files from 2011 to 2016. The study included more than 15.5 million births from the District of Columbia and 18 states that expanded Medicaid (n = 8,530,751) and 17 states that did not (n = 7,100,423). The researchers found no significant changes in preterm birth (< 37 weeks’ gestation), very preterm birth (< 32 weeks; gestation), low birth weight (< 2,500 g) or very low birth weight (< 1,500 g) between the states that expanded Medicaid and those that did not.

However, Brown and colleagues reported that there were significant improvements in disparities for black infants compared with white infants in the Medicaid expansion states across all four outcomes. Hispanic infants did not experience significant improvements in disparities compared with white infants, the researchers wrote.

“The important thing to highlight here is that without a doubt, the biggest declines were in outcomes for black infants,” study researcher Mick Tilford, PhD, a professor and chair of the department of health policy and management in the Fay W. Boozman College of Public Health, said in the release. “Medicaid expansion means continued health insurance for many low-income women. Insurance can lead to healthier mothers, and healthier mothers can lead to healthier babies.”

In an accompanying editor’s note, Howard Bauchner, MD, JAMA editor-in-chief and a professor and vice chair of the department of pediatrics at Boston University School of Medicine and Public Health, and Karen Joynt Maddox, MD, MPH, an assistant professor of medicine at Washington University School of Medicine in St. Louis, noted that the Trump administration has made it “more difficult” for people to obtain health care coverage, and that in 2018, the number of uninsured individuals increased for the first time in 7 years.

“Opponents of further Medicaid expansion argue that the program is too expensive or that if fails to improve health outcomes,” they wrote. “The former critique is the source of ongoing policy debate, but the latter is increasingly proving false. In fact, as the study by Brown and colleagues highlights, Medicaid expansion may be helping to reduce racial disparities in one of the most important health indicators of a society — birth outcomes related to infant mortality.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Photo of Clare Brown 
Clare Brown
Photo of Mick Tilford 
Mick Tilford

States that expanded Medicaid under the Affordable Care Act did not see any significant differences in rates of low birth weight or preterm birth outcomes overall, but there were significant improvements in disparities for black infants, according to research published in JAMA.

“We wanted to see if adverse birth outcomes would be reduced in expansion states relative to nonexpansion states,” Clare Brown, PhD, MPH, instructor in the Fay W. Boozman College of Public Health, said in a press release. “We hypothesized that there would be greater declines among black infants because of the much higher rates of preterm birth and low birth weight among this population.”

Brown and colleagues analyzed U.S. population-based data from the National Center for Health Statistics Birth Data Files from 2011 to 2016. The study included more than 15.5 million births from the District of Columbia and 18 states that expanded Medicaid (n = 8,530,751) and 17 states that did not (n = 7,100,423). The researchers found no significant changes in preterm birth (< 37 weeks’ gestation), very preterm birth (< 32 weeks; gestation), low birth weight (< 2,500 g) or very low birth weight (< 1,500 g) between the states that expanded Medicaid and those that did not.

However, Brown and colleagues reported that there were significant improvements in disparities for black infants compared with white infants in the Medicaid expansion states across all four outcomes. Hispanic infants did not experience significant improvements in disparities compared with white infants, the researchers wrote.

“The important thing to highlight here is that without a doubt, the biggest declines were in outcomes for black infants,” study researcher Mick Tilford, PhD, a professor and chair of the department of health policy and management in the Fay W. Boozman College of Public Health, said in the release. “Medicaid expansion means continued health insurance for many low-income women. Insurance can lead to healthier mothers, and healthier mothers can lead to healthier babies.”

In an accompanying editor’s note, Howard Bauchner, MD, JAMA editor-in-chief and a professor and vice chair of the department of pediatrics at Boston University School of Medicine and Public Health, and Karen Joynt Maddox, MD, MPH, an assistant professor of medicine at Washington University School of Medicine in St. Louis, noted that the Trump administration has made it “more difficult” for people to obtain health care coverage, and that in 2018, the number of uninsured individuals increased for the first time in 7 years.

“Opponents of further Medicaid expansion argue that the program is too expensive or that if fails to improve health outcomes,” they wrote. “The former critique is the source of ongoing policy debate, but the latter is increasingly proving false. In fact, as the study by Brown and colleagues highlights, Medicaid expansion may be helping to reduce racial disparities in one of the most important health indicators of a society — birth outcomes related to infant mortality.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.