Medicaid programs cover a higher proportion of preterm births than private insurance plans, according to a new study from researchers at the George Washington University Milken Institute School of Public Health and the March of Dimes. The study comes out as the nation observes the 13th annual Prematurity Awareness Month.
The study, published in the Journal of Children and Poverty, examined births in the years 2010-2013, coinciding both with passage of the Affordable Care Act and the availability of payment source data on most states' birth certificates in 2010. In the four-year pooled data set, Medicaid and private insurance covered 48.8% and 42.1% of all preterm births respectively. This took place in spite of the fact that private insurance covered more births overall than Medicaid. In addition, Medicaid covered a higher percentage of all very/moderately preterm (50.3% vs. 40.6%) and all late preterm births (48.3% vs. 43.0%).
The study also examined factors that appeared to increase the risk of a preterm birth for women covered by Medicaid. Compared with women who had experienced privately covered preterm births, women who had experienced Medicaid-covered preterm births were more likely to be young (age 12-19), unmarried, black or Hispanic, underweight, and smoking cigarettes during pregnancy. They were also more likely to have less than a high school degree, to have foregone any prenatal care, to have had a prior preterm birth, and to have experienced too short a pregnancy interval between births. In contrast, women who had a privately covered preterm birth were more likely than women who had experienced a Medicaid-covered preterm birth to be white, to have a diagnosis of diabetes, to have eclampsia, and to have undergone a cesarean delivery or infertility treatment.
"Medicaid provides an important source of health coverage for the most vulnerable in our society," said study lead author Anne Markus, PhD, JD, MHS, an associate professor of health policy and management at Milken Institute School of Public Health. "Such coverage helps ensure that at-risk babies and mothers get the care they need for proper development and good health."
"The March of Dimes Prematurity Campaign is pursuing a multi-faceted strategy to prevent preterm birth, including promotion of birth spacing, tobacco cessation, access to the preventive drug 17p, and other interventions," said study co-author Cynthia Pellegrini, Senior Vice President for Public Policy and Government Affairs at the March of Dimes. "This study also provides important insights into how those interventions should be tailored to women who have Medicaid versus private coverage, based on their risk factors."
The authors note that a significant portion of the estimated $26 billion in annual costs associated with preterm birth likely accrues to Medicaid programs. The risk factors identified in this study present significant opportunities for states and other stakeholders to implement interventions to address them, thereby improving birth outcomes and reducing health care costs. Effective interventions include those to improve birth spacing, access to prenatal care, smoking cessation, medication to prevent preterm birth (the drug 17p) and healthy weight in women. Many of these interventions can be delivered through coordinated approaches, such as group prenatal care.
Further research is needed to determine the underlying causes of preterm birth that contribute to higher rates among women with Medicaid coverage. The full study appears in Journal of Children and Poverty and can be viewed online here.