May 5, 2016 Kim Krisberg 2Comment

Just in time for Mother’s Day comes more good news from the Affordable Care Act: the rate of uninsured moms caring for kids younger than 19 has dropped to its lowest rate in nearly 20 years.

According to a new analysis from the Urban Institute released this month, the rate of uninsured moms fell 3.8 percentage points between 2013 and 2014 — that’s a decline about three times as large as any of the previous year-to-year changes observed since 1997. In sheer numbers, that means about 1.6 million moms gained health insurance. To give you even more perspective, consider that uninsurance rates among mothers had increased by more than 2 percentage points from 1997 to 2013, at which point nearly one in every five of America’s moms was living without health insurance.

This not only matters to the health of mothers — who remain the primary caregivers of their families — but to the health of their children too. Beyond the more obvious fact that access to health care is critical to healthy pregnancies, safe childbirth and infant survival, there’s also some evidence that when a mother enjoys good health and well-being, it has positive trickle-down effects for her child’s health and development. For instance, children of mothers who struggle with depression are at higher risk of developing depression themselves. Certain health-related behaviors such as nutritious eating and not smoking — both of which can be influenced by access to medical care — also have a multitude of benefits for kids, not the least of which is reducing exposure to secondhand smoke. And insurance gains among parents are often linked with greater access to care for their children. (Of course, many of the health challenges that mothers face are linked to social determinants — lack of paid sick leave, no maternity leave, wage inequities — and, unfortunately, those won’t be solved with a new health insurance card.)

To conduct the new Urban Institute analysis, researchers examined data on thousands of U.S. moms from the National Health Interview Survey between 1997 and 2014. In addition to the overall decline in uninsured moms, they found that uninsurance among low-income moms fell from 39.4 percent in 1997 to 37.5 percent in 2013 — then it dropped by an additional 6.2 percentage points between 2013 and 2014. (The first ACA open enrollment period was October 2013 to April 2014.) Previous to ACA implementation, mothers in moderate-income families had been experiencing a rise in uninsurance rates between 1997 and 2013, from about 15 percent to 19 percent. However, it dropped to 14 percent in 2014. Among higher-income moms, the uninsurance rate remained stable throughout the study period at less than 4 percent.

Not surprisingly, the analysis found that moms living in states that expanded Medicaid eligibility experienced greater uninsurance declines than those living in nonexpansion states. More specifically, uninsurance rates fell 8.1 percentage points among moms in expansion states and with incomes at or below 138 percent of the federal poverty level. In contrast, that rate fell only 4.9 percentage points in nonexpansion states. Among the mothers who remained uninsured as of 2014, about half were Hispanic and almost half were not working, though only about one-fifth lived in families in which no one was employed. More than 40 percent of uninsured moms in 2014 attributed the lack of coverage to high costs. The next most cited reason was that their coverage stopped after pregnancy.

Overall and despite all the gains, low-income moms are still twice as likely to go without health insurance as moderate-income moms and nearly 15 times as likely to be without insurance as higher-income moms, the analysis reported.

In a Health Affairs blog post by analysis co-authors Michael Karpman, Jason Gates, Genevieve Kenney and Stacy McMorrow, they write: “Together, these findings suggest that by expanding coverage and improving the health and financial stability of mothers and their families, the ACA may be contributing to a healthier, happier Mother’s Day. Perhaps when we toast moms on their special day in 2017, there will be even greater coverage gains to celebrate.”

To download a full copy of the analysis, visit the Urban Institute.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

2 thoughts on “More than 1 million mothers gain health insurance, thanks to the Affordable Care Act

  1. “Previous to ACA implementation, mothers in moderate-income families had been experiencing a rise in uninsurance rates between 1997 and 2013, from about 15 percent to 19 percent. However, it dropped to 14 percent in 2014.”

    That drop may be an anomaly and due only to insurance companies not setting premiums high enough to cover ACA mandates.

    From today’s WSJ:
    “Insurers have begun to propose big premium increases for coverage next year under the 2010 health law, as some struggle to make money in a market where their costs have soared…
    Providence Health Plan, currently the largest insurer for people buying coverage through the Oregon health exchange, is seeking an average increase of 29.6%…
    In Oregon, regulators’ filings show Moda Health Plan Inc., once the largest insurer on the exchange, saying it needs to hike premiums there by an average of 32.3%. That is coming on the heels of an increase of around 25% last year; the insurer also said it would stop selling individual plans in Alaska.”

    Also, from the data in the posted article, I understand that over 31% of low income moms are still uninsured.
    Wasn’t the purpose of the ACA to provide health insurance for everybody, or at least to force everyone to have health insurance?
    Why don’t almost a third of these moms have insurance?
    Is it too expensive?
    If so, just think how expensive health insurance will be under the ACA if *everyone*, including these moms, actually *is*
    forced to have health insurance!

  2. Hi See Noevo,

    According to the data, low- and moderate-income mothers experienced the largest gains in insurance coverage under the ACA — and it’s precisely these types of populations at which much of the law was targeted, as such income groups faced higher risks of being uninsured pre-ACA.

    In terms of low-income moms still being uninsured, much of that is related to the refusal of some states to expand Medicaid eligibility — a transition that is entirely paid for by the federal government. (As I’m sure you know, the ACA was designed under the assumption that all states would expand Medicaid. But the Supreme Court ruling making expansion optional means that millions of Americans now fall in a coverage gap in which they don’t qualify for Medicaid and don’t quality for marketplace subsidies.) So, yes, for many of these moms, insurance is probably still too expensive to purchase without any assistance. However, that was also the problem before the ACA, which is exactly why the feds upped their Medicaid financing.

    And yes, some premiums for some plans in some states have gone up. In other places, premiums went down. But keep in mind that within the marketplace, big rate hikes now have to be reviewed by federal officials and in some states, insurers have to negotiate pricing with state health commissioners. While this certainly isn’t perfect, it means that people buying insurance in the market, as opposed to getting it through an employer, now have an authority advocating for affordability and quality on their behalf. Before, consumers in the individual, private marketplace had NO leverage and were entirely at the mercy of profit-driven insurers. Before the ACA, an individual didn’t buy insurance, they applied for insurance and just had to cross their fingers that they’d gain affordable and regular access to medical care. The ACA has dramatically shifted that paradigm and that’s a good thing, especially if we measure the success of a health care system in actual health outcomes and not in insurance profit margins.

    No one said fixing our health care system would be cheap or quick. But I’d argue that the expense (or investment) is certainly worth it.

    Thanks for reading!

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