 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
E. Kathleen Adams, PhD, Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322, 404-727-9370, eadam01@sph.emory.edu, Norma I. Gavin, PhD, Health, Social and Economics Research, Research Triangle Institute, P.O. Box 12194, Research Triangle Park, NC 27709, Willard G. Manning, PhD, Department of Health Studies, University of Chicago, 5841 S. Maryland Ave., MC2007, Chicago, IL 60637, and Arden S. Handler, DrPH, Community Health Sciences, University of Illinois School of Public Health, 2035 West Taylor, Chicago, IL 60612.
Introduction: Insuring women before/during pregnancy is important to the prevention of unintended pregnancies as well as the early initiation of prenatal care and management of high-risk pregnancies. Medicaid eligibility expanded through the 90’s but national welfare reform [1996] led to declining caseloads/Medicaid enrollment. Even with high economic growth low-income women may have taken jobs not offering insurance or could not afford it. If the net effect was lower coverage just prior to pregnancy, use of early and perhaps adequate, prenatal care could be affected. Objective: To estimate multivariate models of insurance coverage of pregnant women prior to pregnancy, delays in Medicaid enrollment and use of prenatal care among eligible women pre/post welfare reform. Methods: Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for Alaska, Florida, Maine, Oklahoma, New York (upstate), South Carolina, Washington and West Virginia were pooled 1996-1999. PRAMS samples are randomly selected from birth certificates and high-risk pregnancies are over-sampled. Logit models of the probability of being uninsured prior to pregnancy and multinomial logit models on type of insurance [private or Medicaid v. uninsured] and delayed Medicaid enrollment [delay to prenatal or delivery v. no delay] were estimated. Controls included socio-demographics, policy variables and measures of economic growth and insurance markets. Initial models of prenatal care use test the effect of insurance prior to pregnancy and insurance transitions during pregnancy on the use of early and/or adequate care. Results: Post welfare reform all women were less likely while those welfare-eligible were more likely, to be uninsured prior to pregnancy; one reason was that welfare eligible women were less likely to be Medicaid insured than uninsured post welfare reform. Women in states with higher minimum wage/Medicaid eligibility levels were less likely to have private insurance prior to pregnancy and working women eligible for Medicaid were more likely to delay enrollment until delivery. Women in states with higher percentages of uninsured single men were also less likely to be privately insured v. uninsured indicating insurance markets matter. Women uninsured any time during pregnancy were less likely to have early and adequate prenatal care. Conclusions: Descriptively, data indicate the net effect of welfare reform and economic growth was more uninsured women prior to pregnancy in some states. Multivariate analysis indicates that women eligible for Medicaid at welfare levels were those affected and that this occurred more in states where wages were relatively more attractive and insurance markets weaker.
Learning Objectives:
Keywords: Insurance, Pregnancy
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.