Preterm birth and foetal-neonatal death rates associated with the Affordable Care Act Medicaid expansion (2014-19).

Abstract

The Affordable Care Act (ACA) or Patient Protection and Affordable Care Act of 2010 represented a significant expansion of insurance coverage and regulatory reform.1 While initially mandatory, the June 2012 Supreme Court ruling in ‘National Federation of Independent Business v. Sebelius’ established this reform as elective and state-dependent.2 Since 2012, 39 states (and the District of Columbia) have adopted the ACA expanded reform. The ACA expansion increased eligibility for adults with income up to 138% the federal poverty level (FPL).3 In addition, coverage of children had previously varied by state and by age groups, and under the ACA expansion, children ≤18 were covered up to 138% FPL as well. Medicaid currently provides coverage for 40–50% of all pregnancies under a 200% FPL requirement, yet 65% of women subsequently lost postpartum coverage and preventative care.4 The ACA provisions allow for greater coverage of women prior to pregnancy and postpartum, which has resulted in a 28% reduction in insurance churning among low-income women.5 In addition, the rate of uninsured adults in states, which did not adopt the ACA expansion, is twice that of ACA-expanded states.6