Advocates for Evidence-Based Health Policy Speakers
Seize the Day: Expand Medicaid
Infant mortality is a common metric for grading healthcare systems internationally. By that standard, the United States is far from the top of the class, with an abnormally high infant mortality rate for its level of development. While there are methodological concerns about differing data collection standards across nations, even within the United States alarming disparities in infant mortality rates exist. Southern states and minority populations are disproportionally affected. Thus, it’s important to understand factors that may affect infant mortality rates, such as the percentage of population with health insurance.
This study investigated how infant mortality rates varied from 2010 and 2016 between states that expanded versus those that did not expand Medicaid. In the 31 states (and Washington D.C.) that expanded Medicaid, infant mortality declined by 15% from 2010 to 2016. The 19 other states had a decrease of only 11% over those years. In fact, infant mortality in non-expansion states actually bumped up from 6.4 to 6.5 per 1000 births between 2014 and 2016.
Even greater differences were apparent regarding African American infant mortality. Expansion states demonstrated decreased African American infant mortality by 14.5% between 2010 and 2015 while non-expansion states only managed a 6.6% reduction.
In interpreting these results, it is important to note that non-expansion states began with higher infant mortality rates. Combined with the observational nature of the study, it remains impossible to definitively conclude that Medicaid expansion caused the greater decline in infant mortality rates. Nevertheless, that explanation is plausible given the range of health services available to pregnant mothers through Medicaid. Understanding which features of Medicaid might be contributing to improving infant mortality is an worthwhile endeavor.
For now, this study adds evidence to the accumulating research supporting the value of Medicaid expansion. This is especially true for the Southern states that have not expanded Medicaid yet, as their infant mortality rates have long been higher than the national average. Although this study may not provide conclusive evidence linking Medicaid expansion to more infants surviving, it offers a reasonable opportunity that policymakers should seize: expand Medicaid.
Abstract
OBJECTIVES: To explore the effect of Medicaid expansion on US infant mortality rate.
METHODS: We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non-Medicaid expansion states), stratifying data by race/ethnicity.
RESULTS: Mean infant mortality rate in non-Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non-Medicaid expansion states increased from 0.573 (P?=?.08) in 2014 to 0.838 in 2016 (P?=?.006) because of smaller declines in non-Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non-Medicaid expansion states (6.6%: 12.2 to 11.4; P?=?.012).
CONCLUSIONS: Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival.
PMID: 29346003
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