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Pregnancy-related death is a national crisis. Medicaid expansion could help address that.

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Expanding access to Medicaid could dramatically improve pregnant people’s access to health care and address some of the factors driving the nation’s disparity in pregnancy-related and postpartum deaths, according to new research published Tuesday.

The study, published in the journal Health Affairs, followed almost 50,000 pregnant people from 2012 to 2017, comparing what happened in states that expanded Medicaid, an optional component of the Affordable Care Act, versus those that didn’t. In states that opted in, pregnant people’s likelihood of losing insurance in the perinatal period dropped by 10 percentage points.

That’s a big deal. “In the world of health policy,  we don’t often see effect sizes that are that big,” said the study’s lead author Jamie Daw, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health.

Already, pregnant people can more easily qualify for Medicaid coverage, along with two months of postpartum insurance. But after that period ends, or even before, it’s a different story. Especially in states that denied the expansion, many will lose insurance. 

The nation’s death rate for pregnant and postpartum people is among the worst of other wealthy nations. And a third of those deaths actually occur a week to a year after pregnancy. Most are preventable, Daw said — but only if people can sustain access to preventive care, and doctors can catch problems before they spiral.

For people who lose insurance after giving birth, that’s less likely to happen. States with Medicaid expansion were shown to have 1.6 fewer deaths per 100,000 pregnant or postpartum people, a meaningful decrease. Separate research suggests that access to postpartum care improved dramatically after Medicaid expansion— which opened up Medicaid eligibility to people earning 138 percent of the federal poverty level, or, in 2020, $36,156 for a family of four. 

And for those who didn’t have insurance prior to qualifying through pregnancy, it’s harder to immediately access prenatal care or to have chronic health conditions managed — both factors that can make for a worse pregnancy outcome. 

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