Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

The Medicaid income eligibility expansions in the late 1980s were focused on pregnant women and were intended to improve infant health and narrow socioeconomic disparities in health. From this modest beginning, Medicaid has expanded dramatically and the political will to continue expansion remains strong, as evidenced by the recent expansion of SCHIP and state proposals to provide universal health care, which make Medicaid and its look-alike programs the cornerstone of state efforts.

Surprisingly, there is little evidence that the expansion of Medicaid has done much to improve health, or narrow health disparities even among the group it was originally intended to help. For example, simple descriptive statistics on infant mortality and low-birth weight provide little evidence that Medicaid has improved infant health or decreased socioeconomic disparities in infant health. Similar, it is more the exception than the rule that more sophisticated research has uncovered a beneficial effect of Medicaid expansions on infant health.

Nevertheless, the jury is still out on the efficacy of Medicaid vis-à-vis infant health even after more than 20 years of experience. Part of the explanation for the absence of more definitive evidence is because of the absence of suitable data and the difficulty of conducting non-experimental research. There is relatively little data available that has information on both insurance coverage and infant health. Indeed, there is only one study that we are aware of that has examined the effect of the Medicaid expansions on health insurance coverage of pregnant women (Dubay XXXX). The difficulties of conducting non-experimental research in this area are perhaps best illustrated by the cottage industry among health services researchers interested in the effect of the Medicaid expansions on children’s health insurance coverage. This literature has a long and tortured history with a wide spectrum of research results being reported.

In this paper, we begin to address some of these issues. First, we provide an extensive analysis of the effect of Medicaid expansions on the health insurance coverage of pregnant women. As noted, there is virtually no research on this topic even though knowledge of the effects of the expansions on health insurance coverage is essential to any policy evaluation of the effects of Medicaid. Second, we assess the effect of the Medicaid expansions on infant health and use of medical services associated with deliveries (e.g., prenatal care). While this is an area with a substantial amount of research, we pay particular attention to research design issues and assessing the threats to validity that may explain some of the disparate findings of previous research. Third, we combine the two sets of reduced form results to construct implied estimates of the effect of health insurance on infant health and use of medical services associated with deliveries. Here too, we will make a novel contribution as there is no credible evidence of the effect of insurance status on infant health.