On the eve of the 2016 Open Enrollment period for Marketplace coverage, the March of Dimes and Urban Institute released a new study documenting gains in insurance coverage among women of childbearing age in the early stages of implementation of the Patient Protection and Affordable Care Act of 2010 (ACA).
The study, Changes in Insurance Coverage, Access to Care, and Health Care Affordability for Women of Childbearing Age, showed that 5.5 million women of childbearing age gained coverage between summer 2013 (prior to ACA implementation) and winter 2014-15 (after one year of enrollment), reducing the uninsurance rate for this group from 19.6% to 13.3%. However, states’ decisions whether to expand Medicaid were a key determining factor; low-income women in Medicaid nonexpansion states did not experience the same gains as low-income women in expansion states.
”The large declines in uninsurance among women of childbearing age, particularly low-income women, are an encouraging sign,” said Adele Shartzer, a research associate at the Urban Institute’s Health Policy Center and the study’s lead author. “While there is still more to be done to further reduce uninsurance, the ACA appears to be reaching women during a critical period for their own and their family’s health.”
The brief also examined reports of access to and affordability of care. Affordability of care improved, particularly for low-income women in Medicaid expansion states, who reported a 10.4 percentage-point decrease in unmet need for care because of cost. Access to care held steady between summer 2013 and winter 2014–15, with no change in the share of women who reported a usual source of care or recent routine checkup.
“If we can help women be healthy before they become pregnant, they will have healthier pregnancies and healthier babies,” said Cynthia Pellegrini, Senior Vice President for Public Policy and Government Affairs at the March of Dimes, which funded the study. “This study offers critical insights into the impact of the ACA on coverage, access to care, and affordability indicating that the law is indeed enabling more women of childbearing age to obtain coverage. We now must continue working to determine whether that coverage is translating into better health and health outcomes, especially in areas like pregnancy and childbirth.”
The full study, which may be found online here, used data from the Urban Institute’s Health Reform Monitoring Survey (HRMS) to examine changes in uninsurance and health care access and affordability for women of childbearing age (ages 18 to 44). Funding for the core HRMS is provided by the Robert Wood Johnson Foundation and the Urban Institute. The March of Dimes intends to continue tracking key indicators of maternal and child health as 2016 open enrollment begins and Marketplace coverage evolves.