Study: Expanding Medicaid can boost preconception health
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* Kim Krisberg

The time before pregnancy is critical for the health of women and their newborns, and new findings show Medicaid expansion is a promising way of improving health during that period.

In a November study published in Health Affairs, researchers measured changes in 10 preconception health indicators among low-income women in states that expanded Medicaid eligibility under the Affordable Care Act and states that rejected expansion.

As of November, 39 states and Washington, D.C., had expanded Medicaid and 12 states had not. Traditionally, Medicaid required that a woman already be pregnant or have children to qualify for coverage; however, the ACA’s Medicaid expansion broadened coverage to include all low-income women, regardless of whether they are pregnant.

Using years of data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System and its Pregnancy Risk Assessment Monitoring System, researchers found that Medicaid expansions had a positive impact on some preconception health indicators.

“We’re showing improved outcomes for women of lower socioeconomic status,” said study co-author Laura Wherry, PhD, an assistant professor of economics and public service at New York University Wagner Graduate School of Public Service. “These findings could definitely indicate that expanding access to affordable insurance coverage is an important policy lever to reduce disparities in maternal and infant health.”

Wherry and her fellow researchers examined 10 preconception health indicators and looked at changes in the prevalence of certain health conditions and behaviors that can impact maternal health, such as hypertension and smoking.

In Medicaid expansion states, the study found significant improvements for three preconception indicators among low-income women with a recent live birth: preconception health counseling, postpartum use of effective birth control and prepregnancy intake of folic acid before pregnancy, which is recommended to help prevent birth defects.

In particular, the study found a four-percentage-point increase in the share of women in expansion states who reported preconception counseling with a health provider, which is a 22% increase over the pre-Medicaid expansion baseline. Researchers also found a nearly two-percentage-point increase in folic acid intake, which is an increase of almost 10% over baseline. They also found a nearly four-percentage-point increase in the use of effective contraception during the postpartum period, or a 7% increase over baseline.

However, the study did not find evidence that Medicaid expansion has so far led to changes in preconception health indicators related to chronic disease and health behaviors. Wherry noted that suchthose changes typically take longer to materialize than changes in the uptake of preventive health services such as counseling and contraception.

“As policymakers, voters and advocates consider (Medicaid expansion) in their states, documenting changes in states that already expanded is really important,” Wherry told *The Nation’s Health.* “We’re seeing clear evidence of the type of changes that could not only help women lead healthier lives when they’re not pregnant, but can also address important health factors that affect the health of their children.”

For more information on the study, visit [https://bit.ly/3g6iuLP](https://bit.ly/3g6iuLP).

*   Copyright The Nation’s Health, American Public Health Association