Study: Medicaid expansion may reduce racial disparities in birth outcomes

Preterm births and low birth weights have decreased among black infants born in Medicaid expansion states. (Getty/Halfpoint)

Researchers from the University of Arkansas for Medical Sciences’ College of Public Health and the Institute for Medicaid Innovation pored over 15 years worth of infant birth records and found a decrease of low birth weight and preterm births among black babies born in Medicaid expansion states.

Published in April in JAMA Network, the study, which looked at births between 2001 and 2016, concludes that overall there was no significant difference in rates of low birth weight and preterm birth outcomes in association with the introduction of Medicaid expansion.

The same unnoticeable difference was found throughout the specific demographics of white babies and Hispanic babies. However, there were significant reductions in disparities for black infants relative to white infants in states with Medicaid expansion versus those without the Affordable Care Act’s expansion option.


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“We hypothesized that the improvements may be greatest among non-Hispanic black infants. This is simply because non-Hispanic blacks are a more vulnerable population with twice the risk of low birth weight and preterm birth outcomes,” Clare Brown, of the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences and one of the study’s authors, told FierceHealthcare. “Previous studies have also found that racial minorities had larger increases in insurance coverage after Medicaid expansion, so we thought this may translate to larger improvements among this population.”

Researchers looked at data from the National Center for Health Statistics and birth information from 18 states with expanded Medicaid and 17 without.

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Although differences in state Medicaid expansion were not associated with significant differences in rates of preterm birth or low birth weight, questions remain regarding whether Medicaid expansion has had a beneficial effect on health outcomes.

“We don’t have a good answer as to why there is a larger disparity in adverse birth outcomes among black infants,” Brown said. The team suspects the larger improvements found in the study may be related to the relatively higher rates of adverse birth outcomes among this population, “as well as the potentially larger increases in insurance coverage among black individuals after Medicaid expansion,” she added.

Specifically, overall preterm births in expansion states were 6.8% pre-expansion versus 6.67% post-expansion. And for low birth weight, about 5.41% were born with this condition pre-expansion versus 5.36% post-expansion, neither of which are statistically significant on their own. But these reductions made steps to close the gap between white and black infants born with these conditions, the study found

“In fact, as the study by Brown and colleagues highlights, Medicaid expansion may be helping to reduce racial disparities in one of the most important health indicators of a society—birth outcomes related to infant mortality,” Howard Bauchner, M.D., editor-in-chief of JAMA, wrote in an accompanying editor's note.

Since 1990, states have been required to provide Medicaid coverage to low-income pregnant women with family incomes up to 133% of the federal poverty level up to 60 days postpartum. But under the ACA, states may expand Medicaid to adults with household incomes at or below 138% of the federal poverty level, which could improve prenatal care in low-income women.

RELATED: Maternal mortality legislation heads to President Trump's desk for signing

The authors do note, however, that there were limitations that may have affected the outcomes of the study. For example, related studies have found greater improvements in later years after Medicaid expansion, so some positive results may still be on the horizon. Second, the data lack information on maternal factors that could potentially affect birth outcomes.

In conclusion, the authors believe that Medicaid expansion may lead to improvement in the health of mothers, which can ultimately translate to improved infant health.

“Because it may take time for the benefits of access to healthcare to lead to improved health among mothers, there is the potential for Medicaid expansion to be associated with larger reductions in adverse birth outcomes in the long-run,” Brown said.

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