Preconception subsidized insurance: Prenatal care and birth outcomes by race/ethnicity

Low-income pregnant women have been Medicaid eligible since the 1980s, but the Affordable Care Act (ACA)'s expansion of Medicaid to women preconception has the potential to improve pregnancy and birth outcomes by removing delays in Medicaid enrollment. More substantially, the ACA expanded subsidized nongroup maternity coverage. Pre-ACA, nongroup health insurance had generally excluded maternity coverage and was prohibitively expensive for low-income individuals, but the ACA's creation of the Marketplace made maternity coverage mandatory and provides income-based subsidies. I use a simulated eligibility approach to measure how these two aspects of the ACA impacted pregnancy and birth outcomes for first-time mothers, paying special attention to racial-ethnic differences. I find expanding Medicaid to women prior to pregnancy significantly improves the share of women with a prenatal care visit in the first trimester for non-Hispanic Whites and Blacks. Expansions in non-Medicaid subsidized insurance, such as Marketplace insurance, significantly reduce the share of births paid by Medicaid and increased breastfeeding across all racial and ethnic groups. Neither type of subsidized insurance had significant, robust impacts on birth outcomes.