Affordable Care Act likely to lead to better prenatal care for women under 26

1. Ability to stay on parents’ insurance plan through the Affordable Care Act (ACA) was associated with a modest reduction in preterm births, though there were no changes in cesarean delivery rates, low birth weight, or NICU admissions.

2. Women under 26 years old on ACA had increased private insurance payments, reduced Medicaid and self-payment, and increased prenatal care.

Evidence Rating Level: 2 (Good)

Study Rundown: The ACA requires that private insurers allow young adults to be able to stay on their parents’ insurance plans until their 26th birthday. As one-third of US births occur in women that are between 19-25 years old, the ACA is likely to promote increased access to prenatal care and potentially better outcomes. In this retrospective cohort study, women aged 24 to 25 were found to have reduced pre-term births during enactment of the ACA compared to before. In addition, women on ACA had increased private insurance payments, reduced Medicaid and self-payment, and increased early and adequate prenatal care. These changes were primarily observed among unmarried women. Of note, there were no changes in low birth weight, NICU admission, or cesarean delivery.

Overall, this study of 3 million birth suggests that the ACA dependent coverage provision is associated with improved prenatal care. One limitation of the study is that it compared outcomes from earlier years before ACA and later years after ACA, representing a possible confounder based on other changing policies and practices over time. Future directions may include examining other aspects of ACA and insurance coverage on maternal and children’s health outcomes.

Click to read the study, published in JAMA

Relevant Reading: Changes in Health and Medical Spending Among Young Adults Under Health Reform

In-Depth [retrospective cohort]: This study was conducted in the United States and utilized individuals from the Centers for Disease Control and Prevention public-use natality files. The study utilized a difference-in-differences analysis comparing an exposure group of young adults using the ACA provision (24 to 25 years old) to a control group of older adults (27 to 28 years old) across two periods: one before ACA was enacted (2009) and one after (2013). Primary outcomes that were studied in this group were included across 3 domains: insurance status, access to care, and health.

Overall, 3 million births were analyzed in this study. Of these, 1 379 005 births in the exposure group (299 024 in 2009 and 1 079 981 in 2011-2013) and 1 551 192 births in the control group (325 564 in 2009 and 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, the exposure group was found to have increased private payment for birth (1.9%; CI₉₅ 1.6 to 2.1%), increased prenatal care use (1%; CI₉₅ 0.7 to 1.2%) and modest reduction in preterm births (-0.2%; CI₉₅ -0.3 to -0.03). No changes were found in low birth weight, NICU admission, or cesarean delivery (p > 0.05).

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