Does public insurance coverage for pregnant women affect prenatal health behaviors?
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Despite plausible mechanisms, little research has evaluated potential changes in health behaviors in response to expansions in public insurance coverage of the 1980s and 1990s targeted at low-income families. In this paper, we provide the first national study of the effects of Medicaid expansions on health behaviors for pregnant women, which is a group of particular interest given evidence of the importance of prenatal health to later life outcomes. In doing so, we also add to the sparse literature on ex ante moral hazard, which is nearly always mentioned as a theoretical consequence of health insurance, though relatively few empirical studies have assessed its importance. We exploit exogenous variation from the Medicaid income eligibility expansions for pregnant women during late-1980s through mid-1990s to examine the effects of these policy changes on smoking, weight gain, and other maternal health indicators. We find that the 13 percentage point increase in Medicaid eligibility during the study period was associated with approximately a 3% increase in smoking and a small increase in pregnancy weight gain for most of the sample. The increase in smoking, which is a significant cause of poor infant health, may partly explain why Medicaid expansions have not been associated with substantial improvement in infant health.
KeywordsMedicaid Insurance Moral hazard Health Smoking Weight Prenatal care Infant health
JEL ClassificationD1 H0 I12 I13 I18
The authors would like to thank Briggs Depew, Brad Humphreys, Christina Marsh, Joshua Pinkston, Jennifer Trudeau, Wen You, Joshua Graff Zivin, seminar participants at Montana State University, University of Gothenburg, and the Danish Institute for Local and Regional Government Research, and the anonymous referees for helpful comments and suggestions.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Angrist JD, Pischke J-S (2009) Mostly harmless econometrics: an Empiricist's companion. Princeton and OxfordGoogle Scholar
- Baicker K, Finkelstein A, Song J, Taubman S (2013) The impact of Medicaid on labor force activity and program participation: evidence from the Oregon health insurance experiment. National Bureau of Economic Research Working Paper # 19547, CambridgeGoogle Scholar
- Bhattacharya J, Bundorf MK, Pace N, Sood N (2011) Does health insurance make you Fat? In: Grossman M, Mocan N (eds) Economic aspects of obesity. University of Chicago Press, pp 35–64Google Scholar
- Centers for Disease Control and Prevention (2002) Infant mortality and low birth weight among black and white infants—United States, 1980—2000. Morb Mortal Wkly Rep 51(27):589–592Google Scholar
- Chiappori PA (2000) Econometric models of insurance under asymmetric information. In: Dionne G (ed) Handbook of insurance, North HollandGoogle Scholar
- Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D (2017) Early effects of the Affordable Care Act on health care access, risky health behaviors, and self-assessed health. NBER Working Paper 23269Google Scholar
- Curtin SC, Osterman M, Uddin SF, Sutton SR, Reed PR (2013) Source of payment for the delivery: births in a 33-state and District of Columbia reporting area, 2010. Natl Vital Stat Rep 62(5):1–20Google Scholar
- Cutler DM, Zeckhauser R (2000) Insurance markets and adverse selection. In: Cutler AJ, Newhouse JP (eds) Handbook of health economics, North HollandGoogle Scholar
- Dave D, Decker SL, Kaestner R, Simon KI (2008) “Re-examining the effects of Medicaid expansions for pregnant women” National Bureau of Economic Research Working Paper Series, No 14591Google Scholar
- Fortin B, Lanoie P (2000) Incentive effects of worker’s compensation: a survey. In: Dionne G (ed) Handbook of insurance, North HollandGoogle Scholar
- Howell EM, Kenney GM (2012) The impact of the Medicaid/CHIP expansions on children: a synthesis of the evidence. Med Care Res Rev 20:1–25Google Scholar
- Institute of Medicine (2009) Weight gain during pregnancy: reexamining the guidelines, report brief, May 2009Google Scholar
- Kenkel DS (2000) Prevention. In: Culyer AJ, Newhouse JP (eds) Handbook of health economics, North HollandGoogle Scholar
- Kenkel DS, Schmeiser M, Urban C (2014) Is smoking inferior?: evidence from variation in the earned income tax credit. J Hum Resour 49(4):1094–1120Google Scholar
- Levy H, Meltzer D (2004) What do we really know about whether health insurance affects health? In: McLaughlin C (ed) Health policy and the uninsured. Urban Institute Press, Washington D.C, pp 179–204Google Scholar
- Maclean JC, Pesko MF, Hill SC (2017) The effect of insurance expansions on smoking cessation medication prescriptions: evidence from ACA Medicaid expansions. NBER Working Paper # 23450Google Scholar
- Merlis M (2002) Family out-of-pocket spending for health services: a continuing source of financial insecurity, The Commonwealth Fund, www.cmwf.org
- Miller S, Wherry L (2015) The long-term effects of early life Medicaid coverage. Working paper. University of MichiganGoogle Scholar
- National Commission to Prevent Infant Mortality (1988) Death before life: The tragedy of infant mortality, Washington, D.C.: National Commission to Prevent Infant MortalityGoogle Scholar
- Newhouse JP (1993) Free for all? Lessons from the RAND health insurance experiment. In: A RAND study. Harvard University Press, CambridgeGoogle Scholar
- Sommers B, Kronick R, Finegold K, Po R, Schwartz K, Glied S (2012a) Understanding participation rates in Medicaid: implications for the Affordable Care Act, ASPE issue brief, Office of the Assistant Secretary for Planning and Evaluation, https://aspe.hhs.gov/basic-report/understanding-participation-rates-medicaid-implications-affordable-care-act
- Wherry LR, Miller S, Kaestner R, Meyer BD (2017) Childhood Medicaid coverage and later life health care utilization. Review of Economics and Statistics. ForthcomingGoogle Scholar