Insurance Churn Puts Mothers, Newborns at Risk from Coverage Gaps

Almost half of women surveyed had gaps in health insurance coverage in the months before after giving birth. Those gaps create a significant health risk, researchers say.

The months before and after childbirth produce a high percentage of health insurance churn for women, putting the health of mother and child at risk from coverage gaps, according to a report from Harvard T.H. Chan School of Public Health.

Low-income women experience insurance disruptions more than others, the report says. Jamie Daw, the study's lead author and a doctoral student in health policy at Harvard University, notes that the study is the first to use national data to look at month-to-month health insurance coverage for women during and after pregnancy.

"Ideally, every woman would have access to coverage not only for prenatal care and delivery, but also for preconception and extended postpartum care," Daw says.

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"We find there is much more work to be done to ensure that women retain continuous coverage for services we know are critical for reducing adverse birth outcomes and supporting the health of moms and babies."

Data from more than 2,700 women surveyed from 2005-13 by the Medical Expenditure Panel Survey, a nationally representative government survey, indicated that women had the highest rates of coverage at the time of delivery.

But Daw says that coverage masked considerable churning during the prenatal and postpartum months, especially for women who had coverage through Medicaid or the Children's Health Insurance Program (CHIP) in the month of delivery.

Sixty-five percent of women covered by Medicaid or CHIP at delivery were uninsured for at least one month during their pregnancies. In the six months after childbirth, 55% of these low-income women had a gap in coverage for at least one month, and 25% experienced two or more uninsured months. The researchers suggest that those gaps are noteworthy because postpartum depression and other post-childbirth problems may be overlooked or untreated.

Though low-income women were most likely to have insurance gaps, nearly half of all women experienced a period without insurance coverage before or after childbirth, amounting to an estimated 1.8 million families in 2013, according to the authors.

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The high rate of low-income women without insurance after childbirth suggests that many have no viable insurance options other than pregnancy-related Medicaid coverage, which ends 60 days after delivery in all states, the study says.

Risk factors associated with insurance loss after delivery included not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100–185% of the poverty level, the study found.

The study data was collected before the Affordable Care Act's Medicaid expansion in 2014, and the authors note that the ACA probably resulted in significant improvements in continuity of coverage for women before and after childbirth.

But the risk most likely is unchanged for women in the 19 states that chose not to expand Medicaid, where 40% of U.S. babies are born, the researchers said.