The Effects of a Large-Scale Prenatal Care Intervention
Laura Wherry (New York University, Wagner Graduate School of Public Service)
Monday, 11/30/2020, 12:00pm. ARCHIVED EVENT
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One out of every 13 births in the United States is to an undocumented immigrant. Despite this large share of births, undocumented immigrants are ineligible for public health insurance coverage of routine prenatal care in the majority of states. In this paper, we examine the effects of a landmark policy in the state of California to expand eligibility for its Medicaid program to pregnant undocumented immigrants. Using state hospital discharge data, we estimate that nearly 20 percent of births to foreign-born women in the state gained Medicaid coverage under this policy change. We evaluate whether this large expansion in public coverage changed health care utilization during pregnancy for the women who benefited, and whether it improved birth outcomes. We use a novel dataset that links California birth records to the decennial Census and American Community Survey. Using these linked data, we are able to identify siblings of foreign-born mothers born before and after the coverage expansions to compare changes in outcomes associated with exposure to the policy. By comparing outcomes for children born to the same mother, we are able to estimate changes in outcomes resulting from the policy change, rather than from large changes in immigration and the composition of immigrants that occurred during the study period. Our analysis uses siblings of foreign-born mothers who are born entirely during the pre-period or during the post-period as additional comparison groups, as well as the children of U.S. born women, allowing us to net out differences in outcomes due to birth order or any secular trends. Using this approach, we document improved prenatal care utilization and an increase in hospital delivery among pregnant immigrant women under the coverage expansion, as well as increased likelihood of delivery by a physician. We also find significant increases in average gestation length and birth weight among the children who benefited from the policy change while in utero.
Laura Wherry's primary area of research focuses on the changing role of the Medicaid program and its impact on access to health care and health. Recent work examines the early effects of the Affordable Care Act Medicaid expansions, as well as the longer-term effects of several large expansions in Medicaid targeting low-income pregnant women and children in the 1980s and 1990s. Prior to joining NYU, she was an assistant professor at the David Geffen School of Medicine at UCLA and a Robert Wood Johnson Foundation Health & Society Scholar at the University of Michigan.
Laura received her Ph.D. in Public Policy from the University of Chicago's Harris School and her B.A. from the College of William and Mary.