Public Health Insurance Coverage for Immigrants during Pregnancy, Childhood, and Adulthood: A Discussion of Relevant Policies and Evidence.

Context: Despite major expansions in public health insurance under Medicaid and the Children's Health Insurance Program over the last 60 years, many immigrants remain ineligible for coverage.

Methods: The authors discuss the existing federal and state policies that extend public health eligibility to low-income pregnant immigrants, children, and nonelderly adults. They also conduct a literature review and summarize quasi-experimental evidence examining the impact of public health insurance eligibility expansions on insurance coverage, health care use, and health outcomes among immigrants.

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants.

Importance: Professional medical organizations recommend that adults receive routine postpartum care. Yet, some states restrict public insurance coverage for undocumented immigrants and recently documented immigrants (those who received legal documentation status within the past 5 years).

Objective: To examine the association between public insurance coverage and postpartum care among low-income immigrants and the difference in receipt of postpartum care among immigrants relative to nonimmigrants.

Multigenerational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health.

We examine multi-generational impacts of positive in utero health interventions using a new research design that exploits sharp increases in prenatal Medicaid eligibility that occurred in some states. Our analyses are based on U.S.

Medicaid Expansion Led To Reductions In Postpartum Hospitalizations.

The Affordable Care Act (ACA) Medicaid expansions increased preconception and postpartum insurance coverage among low-income birthing people, leading to greater use of outpatient care. In this study we evaluated whether the expansions affected rates of postpartum hospitalization. Our analyses took advantage of underused longitudinal hospital data from the period 2010-17 to examine hospitalizations after childbirth.

Estimated Mortality Increases During The COVID-19 Pandemic By Socioeconomic Status, Race, And Ethnicity.

This article estimates changes in all-cause mortality due to the COVID-19 pandemic by socioeconomic characteristics and occupation for nonelderly adults in the US, using large-scale, national survey data linked to administrative mortality records. Mortality increases were largest for adults living in correctional facilities or in health care-related group quarters, those without health insurance coverage, those with family incomes below the federal poverty level, and those in occupations with limited work-from-home options. For almost all subgroups, mortality increases were higher among non-Hispanic Black respondents than among non-Hispanic White respondents.

Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, And Postpartum Contraception.

The period before pregnancy is critically important for the health of a woman and her infant, yet not all women have access to health insurance during this time. We evaluated whether increased access to health insurance under the Affordable Care Act Medicaid expansions affected ten preconception health indicators, including the prevalence of chronic conditions and health behaviors, birth control use and pregnancy intention, and receipt of preconception health services. By comparing changes in outcomes for low-income women in expansion and nonexpansion states, we document greater preconception health counseling, prepregnancy folic acid intake, and postpartum use of effective birth control methods among low-income women associated with Medicaid expansion.

How Have ACA Insurance Expansions Affected Health Outcomes? Findings From The Literature.

A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chronic disease, maternal and neonatal health, and mortality, with some findings corroborated by multiple studies. Some studies further suggested that the beneficial effects have grown over time and thus may continue to grow if the ACA insurance expansions remain in force.

Childhood Medicaid Coverage and Later-Life Health Care Utilization.

Exploiting a discontinuity in childhood Medicaid eligibility based on date of birth, we find that more years of childhood eligibility are associated with fewer hospitalizations in adulthood. For blacks, we find a 7-15% decrease in hospitalizations and a suggestive 2-5% decrease in emergency department visits, but no similar effect for non-blacks. The effects are pronounced for utilization related to chronic illnesses and for patients living in low-income zip codes.

State Medicaid Expansions for Parents Led to Increased Coverage and Prenatal Care Utilization among Pregnant Mothers.

Objective: To evaluate impacts of state Medicaid expansions for low-income parents on the health insurance coverage, pregnancy intention, and use of prenatal care among mothers who became pregnant.

Data Sources/study Setting: Person-level data for women with a live birth from the 1997-2012 Pregnancy Risk Assessment Monitoring System.

Data Collection/extraction Methods: The sample was restricted to women who were already parents using information on previous live births and combined with information on state Medicaid policies for low-income parents.

State And Federal Coverage For Pregnant Immigrants: Prenatal Care Increased, No Change Detected For Infant Health.

Expanded health insurance coverage for pregnant immigrant women who are in the United States lawfully as well as those who are in the country without documentation may address barriers in access to pregnancy-related care. We present new evidence on the impact of states' public health insurance expansions for pregnant immigrant women (both state-funded and expansions under the Children's Health Insurance Program) on their prenatal care use, mode of delivery, and infant health. Our quasi-experimental design compared changes in immigrant women's outcomes in states expanding coverage to changes in outcomes for nonimmigrant women in the same state and to women in nonexpanding states.

Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions.

Background: By September 2015, a total of 29 states and Washington, D.C., were participating in Medicaid expansions under the Affordable Care Act.

Previous Medicaid Expansion May Have Had Lasting Positive Effects On Oral Health Of Non-Hispanic Black Children.

Healthy tooth development starts early in life, beginning even before birth. We present new evidence suggesting that a historic public health insurance expansion for pregnant women and children in the United States in the 1980s and 1990s may have had long-lasting effects on the oral health of the children gaining eligibility. We estimated the relationship between adult oral health and the extent of state public health insurance eligibility for pregnant women, infants, and children throughout childhood separately for non-Hispanic whites, non-Hispanic blacks, and Hispanics.

Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study.

Background: In 2014, only 26 states and the District of Columbia chose to implement the Patient Protection and Affordable Care Act (ACA) Medicaid expansions for low-income adults.

Objective: To evaluate whether the state Medicaid expansions were associated with changes in insurance coverage, access to and utilization of health care, and self-reported health.

Design: Comparison of outcomes before and after the expansions in states that did and did not expand Medicaid.

The Role of Public Health Insurance in Reducing Child Poverty.

Over the past 30 years, there have been major expansions in public health insurance for low-income children in the United States through Medicaid, the Children's Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its effect on health care utilization and health outcomes, with much less attention to the financial protection it offers families.

Predicting high-cost pediatric patients: derivation and validation of a population-based model.

Background: Health care administrators often lack feasible methods to prospectively identify new pediatric patients with high health care needs, precluding the ability to proactively target appropriate population health management programs to these children.

Objective: To develop and validate a predictive model identifying high-cost pediatric patients using parent-reported health (PRH) measures that can be easily collected in clinical and administrative settings.

Design: Retrospective cohort study using 2-year panel data from the 2001 to 2011 rounds of the Medical Expenditure Panel Survey.

Using self-reported health measures to predict high-need cases among Medicaid-eligible adults.

Objective: To assess the ability of different self-reported health (SRH) measures to prospectively identify individuals with high future health care needs among adults eligible for Medicaid.

Data Sources: The 1997-2008 rounds of the National Health Interview Survey linked to the 1998-2009 rounds of the Medical Expenditure Panel Survey (n = 6,725).

Study Design: Multivariate logistic regression models are fitted for the following outcomes: having an inpatient visit; membership in the top decile of emergency room utilization; and membership in the top cost decile.

Medicaid family planning expansions and related preventive care.

I examined the impact of state expansions in eligibility for Medicaid family planning services on the utilization of Papanicolaou (Pap) tests, clinical breast examinations, HIV testing, and routine doctor check-ups among women aged 21 to 44 years using the Behavioral Risk Factor Surveillance System (1993-2009). Using a natural experiment approach, I found significant increases in Pap tests and clinical breast examinations among women eligible for services under the expansions but no significant change in HIV testing or routine doctor check-ups.

Changes in health insurance coverage and health status by race and ethnicity, 1997-2002.

Recent years have seen shifts in health insurance coverage associated with economic fluctuations and changes in health policy. The analysis presented here uses data from the National Survey of America's Families to examine changes in health insurance coverage and respondent-reported health status by race and ethnicity. The data indicate that public coverage increased for black, Hispanic and white children between 1997 and 2002.