Daw Jamie R, Winkelman Tyler N A, Dalton Vanessa K, Kozhimannil Katy B, Admon Lindsay K
Jamie R. Daw (
Tyler N. A. Winkelman is a clinician-investigator at Hennepin Healthcare and codirector of the Health, Homelessness, and Criminal Justice Lab at Hennepin Healthcare Research Institute, in Minneapolis, Minnesota.
Health Aff (Millwood). 2020 Sep;39(9):1531-1539. doi: 10.1377/hlthaff.2019.01835.
Insurance churn, or moving between different insurance plans or between insurance and uninsurance, is common during the perinatal period. We used survey data from the 2012-17 Pregnancy Risk Assessment Monitoring System to estimate the impact of Affordable Care Act-related state Medicaid expansions on continuity of insurance coverage for low-income women across three time points: preconception, delivery, and postpartum. We found that Medicaid expansion resulted in a 10.1-percentage-point decrease in churning between insurance and uninsurance, representing a 28 percent decrease from the prepolicy baseline in expansion states. This decrease was driven by a 5.8-percentage-point increase in the proportion of women who were continuously insured and a 4.2-percentage-point increase in churning between Medicaid and private insurance. Medicaid expansion improved insurance continuity in the perinatal period for low-income women, which may improve the quality of perinatal health care, but it also increased churning between public and private health insurance.
保险变更，即在不同保险计划之间转换或在参保与未参保之间变动，在围产期很常见。我们使用了2012 - 2017年妊娠风险评估监测系统的调查数据，以估计《平价医疗法案》相关的州医疗补助扩大计划对低收入女性在三个时间点（孕前、分娩时和产后）保险覆盖连续性的影响。我们发现，医疗补助扩大计划使参保与未参保之间的变动率降低了10.1个百分点，相较于扩大计划实施前的基线水平，在扩大计划实施的州下降了28%。这一下降是由持续参保女性比例上升5.8个百分点以及医疗补助与私人保险之间的变动率上升4.2个百分点推动的。医疗补助扩大计划改善了低收入女性围产期的保险连续性，这可能会提高围产期医疗保健质量，但同时也增加了公共和私人医疗保险之间的变动率。
