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ACA dependent coverage provision associated with increased use of prenatal care

February 13, 2018

Bottom Line: The dependent coverage provision of the Affordable Care Act (ACA) that allowed young adults to stay on their parents' insurance until they were 26 was associated with increased use of prenatal care, increased private insurance payment for births, and a modest reduction in preterm births.

Why The Research Is Interesting: Nearly one-third of U.S. births are to women in the age range of the ACA dependent coverage provision (19-25 years). The effect of this provision on pregnancy-related health care and health outcomes had not been known.

Who and When: Nearly 3 million births among women ages 24 to 25 (exposure group within the age range of the ACA provision) and women ages 27 to 28 (older control group outside the provision's age range) before (in 2009) and after enactment of the ACA dependent coverage provision (2011-2013)

What (Study Measures): Dependent coverage provision of the ACA (exposure); payment source for births, early and adequate prenatal care (outcomes).

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Jamie R. Daw, M.Sc., Harvard Medical School, and Benjamin D. Sommers, M.D., Ph.D., Harvard T. H. Chan School of Public Health, Boston

Results: In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission.

Study Limitations: The dependent coverage provision may have had a different effect on women younger than those included in this analysis, among whom rates of prenatal care are typically lower and risk of adverse birth outcomes are higher.

Conclusions: The ACA's dependent coverage provision is one of many components of the law with the potential to affect reproductive-age and pregnant women. Further research should focus on other aspects of the law on insurance coverage during pregnancy and the effects on access to care, maternal outcomes and children's health outcomes.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jama.2018.0030)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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JAMA

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