How Did Medicaid Expansion Affect Low Birth Weights and Preterm Births? Interview with:

Clare Brown, PhDHealth Systems and Services ResearchUniversity of Arkansas for Medical Sciences

Dr. Brown

Clare Brown, PhD
Health Systems and Services Research
University of Arkansas for Medical Sciences

J. Mick Tilford, PhD, Professor and ChairDepartment of Health Policy and ManagementFay W. Boozman College of Public HealthUniversity of Arkansas for Medical Science

Dr. Tilford

J. Mick Tilford, PhD,
Professor and Chair

Department of Health Policy and Management
Fay W. Boozman College of Public Health
University of Arkansas for Medical Science What is the background for this study? What are the main findings? 

Response: Prematurity and low birthweight are associated with increased risk of infant mortality as well as increased risk of chronic conditions throughout infancy and into adulthood. Non-Hispanic black infants are twice as likely to be born low birthweight (13.9% vs 7.0%) and 1.5 times as likely to be born prematurely (13.9% vs 9.1%) compared to non-Hispanic white infants.

Under the Affordable Care Act (ACA), states may expand Medicaid to adults with household income levels at or below 138% of the federal poverty level, thus extending coverage to childless adults and improving continuity. Insurance gain may ultimately improve maternal health, increased use and earlier initiation of prenatal care services, and improved access to pregnancy planning resources.

Our study aimed to evaluate whether there were changes in rates of low birthweight and preterm birth outcomes among states that expanded Medicaid versus states that did not expand Medicaid. What is the background for this study? What are the main findings? 

Response: We found that state Medicaid expansion was not significantly associated with differences in adverse birth outcomes overall; however, there were significant improvements in disparities of all four birth outcomes for black infants relative to white infants among states that expanded Medicaid compared with those that did not. What should readers take away from your report?

Response: Medicaid expansion was associated with a decline in disparities in rates of adverse birth outcomes between non-Hispanic black infants and non-Hispanic White infants. What recommendations do you have for future research as a result of this work?

Response: Further analyses with data that are better able to identify women who were newly insured may provide estimates that more directly reflect the impact of Medicaid expansion on birth outcomes. Is there anything else you would like to add?

Response: The improved birth outcomes among vulnerable populations found in this study likely explain the reductions in infant mortality rates among non-Hispanic black infants in expansion states found in a previous study.1 Given the associations between low birthweight and preterm birth with consequent health outcomes, the reduction in disparities in low birthweight and preterm births found in this study may ultimately result in improvements in racial disparities in chronic conditions over the life course as well.

  1. Bhatt, C. B., & Beck-Sagué, C. M. (2018). Medicaid expansion and infant mortality in the United States. American journal of public health, 108(4), 565-567. 


Brown CC, Moore JE, Felix HC, et al. Association of State Medicaid Expansion Status With Low Birth Weight and Preterm Birth. JAMA. 2019;321(16):1598–1609. doi:10.1001/jama.2019.3678




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