Medicaid expansion and infant mortality, revisited: A difference-in-differences analysis
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Updated: Dec 25, 2025

Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Alexandra Wiggins1, Ibraheem M Karaye2, Jennifer A Horney2
1Department of Biology, University of Dayton, Dayton, Ohio.
Objective:
To determine the association between Medicaid expansion and infant mortality rate (IMR) in the United States.
Data Sources:
State-level aggregate data on US IMR, race, and sex were abstracted from the US Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research.
Study Design:
The association between Medicaid expansion and IMR adjusted for race and sex was assessed with multiple linear regression models using difference-in-differences estimation and Huber-White robust standard errors.
Principal Findings:
Difference-in-differences regression found no association between Medicaid expansion status and change in national IMR from 2010 to 2017 (Coef. = 0.04; 95% CI: -0.39, 0.46). However, among Hispanics, the program was found to be associated with reduction in IMR (Diff-in-Diff Coef. = -0.53; 95% CI: -1.02, -0.03).
Conclusions:
Overall, the Affordable Care Act-induced Medicaid expansion was not associated with IMR reduction in expansion states relative to nonexpansion states. However, the program was associated with a significant IMR decline among Hispanics.
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