Does Perinatal Insurance Churn Impact Birth Outcomes? An Analysis of 2012-2015 Data from the Pregnancy Risk Assessment Monitoring System

In the United States 1 in 10 neonates are born prematurely impacting an estimated 450 000 births per year. Preterm birth is the leading cause of neonatal and infant mortality and many survivors experience lifelong morbidity and disability. The United States ranks extremely poorly in preterm birth rates compared to peer nations and provides the costliest care to those born prematurely an estimated 26 billion dollars per year. Preconception and prenatal care reduces preterm birth rates neonatal intensive care unit admissions and neonatal costs. Landmark analyses have recently revealed that extremely high proportions of delivering women experience disruptions and transitions ('churn') in health insurance coverage in the perinatal period. The most recent data estimate that 58% of all pregnant women experience a change in insurance in the nine months leading up to and including delivery and 62% of women experience at least one month when they are uninsured during that time. The frequency of disruptions and transitions in insurance coverage in the perinatal period may contribute to the disparity in preterm birth rates between the US and other developed countries. Better understanding these relationships has been deemed critical research gap by the Maternal and Child Health Bureau (MCHB) at the Health Resources and Services Administration. The proposed analyses will use 2012-2015 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to generate updated estimates of insurance churn in the United States and draw comparisons across Medicaid expansion and non-expansion states (Aim 1) examine the relationship between insurance churn and preterm birth (Aim 2) and describe these relationships among women with chronic conditions (diabetes hypertension obesity and depression) who are at among the highest risk for both insurance churn and preterm birth (Aim 3). These data are critical to informing health policy decisions surrounding insurance benefits design and eligibility and improving health outcomes for America's most vulnerable mothers and their infants.

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Daw JR, Winkelman TNA, Kozhimannil KB, Dalton VK, Admon LK. Medicaid Expansion Improved Perinatal Insurance Continuity For Low-Income Women. Health Affairs. 2020;(39)9:1531-1539. DOI:10.1377/hlthaff.2019.01835 September 2020