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TOPLINE
The 2014 Medicaid expansion under the Affordable Care Act was not associated with a reduction in rates of severe maternal morbidity (SMM) during delivery hospitalizations.
METHODOLOGY
- Researchers conducted a retrospective, repeated cross‑sectional study to assess whether the 2014 Medicaid expansion was associated with changes in SMM rates during delivery hospitalizations.
- They analyzed more than 11.9 million delivery hospitalizations among women aged 19-45 years in 26 states between 2010 and 2018, excluding 2014 as a washout year.
- Data were compared between 16 states that expanded Medicaid in January 2014 and 10 states that did not.
- The primary outcome was SMM during delivery hospitalization, identified using CDC criteria that excluded blood transfusion. The secondary outcome was the proportion of deliveries paid by Medicaid.
TAKEAWAY
- Researchers identified 82,903 SMM events, corresponding to a rate of 69.2 per 10,000 deliveries.
- Medicaid expansion was associated with a 5.2-percentage point increase in the proportion of deliveries paid by Medicaid.
- Medicaid expansion was not associated with a statistically significant change in the SMM rate during delivery hospitalizations. This finding was consistent across racial and ethnic subgroups and in sensitivity analyses.
IN PRACTICE
"Although further study of the effects of ACA [Affordable Care Act] implementation beyond the childbirth hospitalization are needed, additional clinical and policy interventions may be required to improve maternal health outcomes," the authors wrote.
SOURCE
The study was led by Jean Guglielminotti, MD, PhD, Columbia University Vagelos College of Physicians and Surgeons in New York City. It was published online on August 27 in Obstetrics and Gynecology.
LIMITATIONS
The exposure may have been misclassified. The study period included the switch in diagnostic coding in October 2015, which may have caused an abrupt change in the SMM rate. Researchers could not account for women with more than one birth.
DISCLOSURES
The study was supported in part by the National Institute on Minority Health and Health Disparities, National Institutes of Health. The authors did not report any conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
