Women of childbearing age gain health coverage in ACA expanded states

Smiley pregnant

On the eve of the 2016 Open Enrollment period for Marketplace coverage, the March of Dimes and Urban Institute released a new study documenting gains in insurance coverage among women of childbearing age in the early stages of implementation of the Patient Protection and Affordable Care Act of 2010 (ACA).

Why is this study important? Here are some findings previous to the implementation of the ACA:

  • In 2013, more than one in five women of childbearing age was uninsured (Cohen and Martinez 2014).
  • Women who do not have health insurance coverage are more likely to forgo necessary medical care because of cost and have lower rates of preventive screenings, such as Pap Smears and mammography (Kaiser Family Foundation 2013).
  • Studies have also shown that access to preconception and interconception care can improve the health of women and their future children by addressing chronic health conditions and risk behaviors associated with adverse pregnancy outcomes (Atrash 2006; Moos and Cefalo 1987).
  • Adequate preconception care for women of childbearing age can also reduce disparities in adverse pregnancy outcomes (Johnson et al. 2006).
  • Health insurance coverage facilitates access to care because women who are uninsured before becoming pregnant are less likely to receive preconception counseling (Williams et al. 2012).

The study, Changes in Insurance Coverage, Access to Care, and Health Care Affordability for Women of Childbearing Age, showed that 5.5 million women of childbearing age gained coverage between summer 2013 (prior to ACA implementation) and winter 2014-15 (after one year of enrollment), reducing the uninsurance rate for this group from 19.6% to 13.3%.  However, states’ decisions whether to expand Medicaid were a key determining factor; low-income women in Medicaid non-expansion states did not experience the same gains as low-income women in expansion states.

“The large declines in uninsurance among women of childbearing age, particularly low-income women, are an encouraging sign,” said Adele Shartzer, a research associate at the Urban Institute’s Health Policy Center and the study’s lead author.  “While there is still more to be done to further reduce uninsurance, the ACA appears to be reaching women during a critical period for their own and their family’s health.”

The brief also examined reports of access to and affordability of care. Affordability of care improved, particularly for low-income women in Medicaid expansion states, who reported a 10.4 percentage-point decrease in unmet need for care because of cost.  Access to care held steady between summer 2013 and winter 2014–15, with no change in the share of women who reported a usual source of care or recent routine checkup.

“If we can help women be healthy before they become pregnant, they will have healthier pregnancies and healthier babies,” said Cynthia Pellegrini, Senior Vice President for Public Policy and Government Affairs at the March of Dimes, which funded the study.  “This study offers critical insights into the impact of the ACA on coverage, access to care, and affordability indicating that the law is indeed enabling more women of childbearing age to obtain coverage.  We now must continue working to determine whether that coverage is translating into better health and health outcomes, especially in areas like pregnancy and childbirth.”

The full study, which may be found online,  used data from the Urban Institute’s Health Reform Monitoring Survey (HRMS) to examine changes in uninsurance and health care access and affordability for women of childbearing age (ages 18 to 44).  Funding for the core HRMS is provided by the Robert Wood Johnson Foundation and the Urban Institute. The March of Dimes intends to continue tracking key indicators of maternal and child health as 2016 open enrollment begins and Marketplace coverage evolves.


  • Award-winning journalist, author, multicultural expert, public speaker, small business advocate and the Editor-in-Chief of LatinasinBusiness.us. Susana is an Argentinean immigrant who started her own small business over 20 years ago. Now, through her new digital platform and social media channels, she advocates for the economic empowerment of Latinas in the United States.

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