HLTH 350 Week 6 Article Review 3 Example

Coverage Before Birth: A Review of Evidence That Medicaid Expansion Lowered Infant Mortality, Most of All for Black Infants

Introduction

Infant mortality, counted as deaths of children under one year old, works as a summary signal for a community, since it captures how healthy women are before and during pregnancy, how good local care is and how families are living. Bhatt and Beck-Sagué (2018) asked whether expanding Medicaid, which extended coverage to many low-income women before pregnancy, was associated with changes in infant mortality.

Summary

The authors compared infant mortality rates from 2010 to 2016 in states that broadened Medicaid eligibility in 2014 with those in states that kept their old rules. From 2014 to 2016, average infant deaths per 1,000 births dropped from 5.9 to 5.6 in expansion states but rose slightly from 6.4 to 6.5 in nonexpansion states, so the gap between the two groups grew from about 0.57 to 0.84 deaths per 1,000. The decline was 15.2% in expansion states and 11.0% in nonexpansion states over the longer period studied. The difference was largest for Black infants: in expansion states, their mortality rate fell 14.5%, from 11.7 to 10.0 per 1,000, more than twice the 6.6% decline in nonexpansion states, where the rate went from 12.2 to 11.4. Because Black infants die at nearly twice the rate of White infants nationally, a policy that helps them most could narrow one of the country's most persistent health gaps.

Suggestions to Address the Problem

McKenzie et al. (2012) explain that many infant deaths are linked to preterm birth and low birth weight, which can be reduced when women receive care before and early in pregnancy. They also explain that access to care depends heavily on insurance. Three suggestions follow. First, the remaining nonexpansion states could expand Medicaid, since the evidence links expansion to lower infant mortality. Second, coverage should begin before pregnancy, so that chronic conditions such as high blood pressure and diabetes are treated before conception. Third, health departments should pair coverage with outreach, such as home visiting and help enrolling, so women actually begin prenatal care early. A larger study supports the focus on disparities. Brown et al. (2019) examined more than 15 million births and found little overall change in preterm birth or low birth weight after expansion, but a narrowing of the gaps between Black and White infants. Coverage may not change the national average quickly, but it can begin to close the gap for the babies who face the greatest risk.

Conclusion

The study is short and observational, so it cannot prove that Medicaid expansion caused the decline. It also covers only the first years after expansion, before effects on women's health before pregnancy could fully appear. Still, together with larger studies of birth outcomes, it suggests that coverage for low-income women is a promising tool for reducing infant deaths and racial disparities.

References

Bhatt, C. B., & Beck-Sagué, C. M. (2018). Medicaid expansion and infant mortality in the United States. American Journal of Public Health, 108(4), 565-567. https://doi.org/10.2105/AJPH.2017.304218

Brown, C. C., Moore, J. E., Felix, H. C., Stewart, M. K., Bird, T. M., Lowery, C. L., & Tilford, J. M. (2019). Association of state Medicaid expansion status with low birth weight and preterm birth. JAMA, 321(16), 1598-1609. https://doi.org/10.1001/jama.2019.3678

McKenzie, J. F., Pinger, R. R., & Kotecki, J. E. (2012). An introduction to community health (7th ed.). Jones & Bartlett Learning.