New York's Basic Health Program Increased Subsidized Insurance Coverage From Preconception To The Postpartum Period

Prepregnancy access to care and continuous health insurance coverage from preconception to postpartum are modifiable drivers of maternal health. The Basic Health Program (BHP) provision of the Affordable Care Act (ACA) allows states to provide low-income people with earnings above the Medicaid income threshold with insurance coverage that is more affordable than Marketplace plans. This study used data from the Pregnancy Risk Assessment Monitoring System from the period 2015-20 and a difference-in-differences design to evaluate the impact of New York's BHP on two insurance outcomes: preconception coverage through New York's state BHP or Marketplace and continuous publicly subsidized coverage during and after pregnancy following prepregnancy BHP or Marketplace coverage. Compared with coverage in comparison states with no BHP, New York's BHP increased preconception BHP and Marketplace coverage by 8.8 percentage points and increased continuous publicly subsidized coverage pre- to postpregnancy by 6.9 percentage points. The BHP was not associated with a change in preconception uninsurance. The BHP could be an important state-level policy to improve coverage affordability and stability from preconception to the postpartum period, especially given the present uncertainty of federal funding for Medicaid and Marketplace coverage.