The Impact of the Affordable Care Act on U.S. Maternal Mortality [21J

Abstract

INTRODUCTION: Between 2013-2014 the Maternal Mortality Rate in the United States was 21-22 per 100,000 - the worst among high-income countries. The World Health Organization attributes this in part to inadequate prenatal supervision. The Affordable Care Act (ACA) was fully implemented in 2014 and has provisions to increase access to health insurance and thus prenatal care. This study aims to determine any relationship between the 2014 implementation of the ACA on prenatal care attendance and maternal mortality. METHODS: State-level data from the Census Bureau and CDC was used to perform a multivariate logistic regression (ANOVA) on Percentage of Mothers Receiving Prenatal Care in First Trimester and Percentage of Uninsured Patients and their relationship to maternal mortality (MM) before and after the full implementation of the ACA nationwide. RESULTS: 2014 data demonstrates a statistically significant relationship between MM and the percentage of uninsured patients with the ACA (r= 0.33, p=0.017) not found prior to the ACA implementation (2012: r=0.33, p=0.120) and (2013: r=0.17, p=.0214). A negative correlation between prenatal care in the first trimester with MM was statistically significant in 2012 (r=-0.402, p=0.011) and 2013 (r=-0.395, p=0.009) but this was increased in 2014 with ACA(r =-0.523, p = 0.0001). CONCLUSION: Preliminary analysis found a negative correlation between maternal mortality and percentage of prenatal care in the first trimester, this became increasingly statistically significant in 2014 with the ACA implementation. Similarly, a positive correlation was found between maternal mortality and percentage of uninsured patients by state that became statistically significant only after 2014 with the ACA implementation.