在医疗补助持续覆盖期间产后覆盖的种族不平等:来自ACA扩张与非扩张州的证据
Teresa Janevic1, Heeun Kim2, Annabelle Ng3
1Columbia University Mailman School of Public Health, New York, NY.
American journal of preventive medicine
|February 16, 2026
概括
延长怀孕医疗补助覆盖范围减少了非扩张州黑人妇女分娩后的无保险. 然而,尽管持续有保险政策,但保险覆盖的种族不平等仍然存在.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
背景情况:
- 将孕妇医疗补助计划的覆盖范围扩展到产后12个月是减少孕妇发病率和死亡率的关键策略.
- 这一政策可能在那些没有根据"负担得起的医疗法案" (ACA) 扩大医疗补助的州尤其具有影响力.
- 随着COVID-19大流行,持续的医疗补助覆盖提供了一个独特的机会来研究产后医疗补助延期的影响.
研究的目的:
- 评估持续的医疗补助保险对产后保险费率的影响.
- 为了比较非西班牙裔黑人和白人妇女在医疗补助扩张和非扩张州产后保险的变化.
- 评估持续保险对产后无保险的种族差异的影响.
主要方法:
- 使用横截面前后设计分析2016-2023年美国社区调查 (ACS) 数据.
- 包括19-50岁的非西班牙裔黑人和白人女性,在过去12个月内分娩 (n=157,016).
- 采用线性回归模型,比较扩张和非扩张状态的前后连续覆盖范围 (2019参考年),调整为共变量.
主要成果:
- 在疫情前,黑人女性的无保险率在非扩张州为16.5%,而在扩张州为6.4%,白人女性为11.1%,而5.4%.
- 在连续覆盖之后,黑人妇女的产后无保险在非扩张状态下比在扩张状态下下降得更大.
- 虽然白人妇女在非扩张状态中也出现了无保险下降 (由私人保险收益驱动),但产后无保险的黑白人差异保持不变.
结论:
- 持续的医疗补助覆盖率导致非扩张州的黑人妇女产后不保险减少.
- 尽管减少了,但在产后保险覆盖方面仍存在持续的种族不平等.
- 这些发现强调了医疗补助政策,持续覆盖和在获得孕产妇医疗保健方面的种族差异之间的复杂相互作用.
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