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Principal Investigator: Jean R Guglielminotti
Organization: COLUMBIA UNIVERSITY HEALTH SCIENCES
Fiscal Year: 2024
Award: $369,826
Funding agency: National Institute on Minority Health and Health Disparities
The long-term goal of the proposed research project is to improve the health of minoritized racial and
ethnic birthing people by reducing racial and ethnic disparities in severe maternal morbidity and maternal
mortality. Specifically, the proposed research project will assess the effectiveness of 3 significant health
insurance expansion policies in reducing racial and ethnic disparities in severe maternal morbidity
(SMM): 1) the 2010 Dependent Coverage Provision under the Patient Protection and Affordable Care Act
(ACA), requiring private health insurers to allow young adults to remain on their parent’s plan until their 26th
birthday; 2) the 2014 ACA Medicaid expansion, giving states the option to expand Medicaid coverage to non-
elderly adults with incomes up to 138% of the Federal Poverty Level; and 3) the Maintenance of Effort of the
2020 Families First Coronavirus Response Act (FFCRA) temporarily maintaining Medicaid coverage beyond
60-days postpartum as long the COVID-19 Public Health Emergency is in place.
Minoritized racial and ethnic birthing people are three times more likely than non-Hispanic White people
to experience SMM during childbirth and the postpartum. Addressing racial and ethnic disparities in SMM
is recognized as an urgent public health priority. SMM refers to unintended serious complications of labor
and delivery and is associated with substantially increased risk of maternal death. Providing continuous health
insurance coverage through health policies, from preconception to 1-year postpartum, is a suggested
intervention to mitigate these disparities. Up to 80% of minoritized racial and ethnic birthing people do not have
such continuous coverage. However, evidence linking health insurance policy changes to reduced racial
and ethnic disparities in SMM is scant. The 2010 ACA Dependent Coverage Provision, the 2014 ACA
Medicaid expansion, and the 2020 FFCRA Maintenance of Effort present three natural experiments for
assessing the effectiveness of expanding health insurance coverage in reducing racial and ethnic disparities in
SMM. The proposed project will test a series of hypotheses related to the specific aims, including: 1) Expanded
access to private health insurance for people under age 26 is associated with reduced racial and ethnic
disparities in SMM; 2) Expanded Medicaid coverage for low-income people is associated with reduced racial
and ethnic disparities in SMM, and 3) Extending Medicaid coverage for low-income people from 60-day to 1-
year postpartum is associated with reduced racial and ethnic disparities in postpartum SMM. National and
state data from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, will
be analyzed using robust quasi-experimental approaches such as the difference-in-difference-in-differences.
Results of this project will help close important gaps in health disparities research and provide
rigorous evidence to inform policy interventions to reduce racial and ethnic health disparities among
birthing people. It aligns with the aims of the IMPROVE initiative of the National Institutes of Health.
Terms: <21+ years old><AHCPR><AHRQ><Address><Adopted><Adoption><Adult><Adult Human><Affect><Affordable Care Act><Age><Agency for Health Care Policy and Research><Agency for Healthcare Research and Quality><Birth><COVID-19><CV-19><Childbirth><Conceptions><Coronaviridae><Coronavirus><Coronavirus Infectious Disease 2019><Data><Data Bases><Databases><Decrease disparity><Economic Income><Economical Income><Effectiveness><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Evaluation><Family><Gestation><Goals><Health><Health Care Costs><Health Costs><Health Disparities Research><Health Insurance><Health Policy><Health disparities related research><Healthcare Costs><Hospital Admission><Hospitalization><Incidence><Income><Inpatients><Insurance Carriers><Insurance Coverage><Insurance Status><Insurers><Intervention><Intervention Strategies><Labor Complications><Link><Low Income Population><Low income><Low income group><Lower disparity><Maintenance><Maternal Health><Maternal Mortality><Medicaid><Methods><NIH><National Institutes of Health><Natural experiment><New York><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Obamacare><Parents><Parturition><Patients><Persons><Policies><Postpartum Period><Pregnancy><Privatization><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><R-Series Research Projects><R01 Mechanism><R01 Program><Research><Research Grants><Research Project Grants><Research Projects><Sampling><Series><Testing><Uninsured><United States Agency for Health Care Policy and Research><United States Agency for Healthcare Research and Quality><United States National Institutes of Health><Variant><Variation><adult youth><adulthood><aged><ages><assess effectiveness><child birth><corona virus><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><data base><determine effectiveness><disparities in race><disparity due to race><disparity in ethnic><disparity in health><disparity reduction><effectiveness assessment><effectiveness evaluation><ethnic based disparity><ethnic disadvantage><ethnic disparities in health><ethnic disparity><ethnic health disparity><ethnic inequality><ethnic inequity><ethnic subgroup><ethnicity disparity><ethnicity group><evaluate effectiveness><examine effectiveness><experience><federal policy><federal poverty level><health care policy><health data><health disparities science><health disparity><health insurance plan><healthcare policy><hospital re-admission><hospital readmission><improve minority health><improvement of minority health><incomes><indexing><inequality due to race><inequity due to race><interventional strategy><low income individual><low income people><maternal death><maternal risk><mitigate disparity><parent><policy recommendation><post-partum><public health emergency><public health priorities><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparities in health><racial disparity><racial health disparity><racial inequality><racial inequity><racial minority><racially unequal><re-admission><re-hospitalization><readmission><recommendation for policy><reduce disparity><reduction in disparity><rehospitalization><response><severe maternal morbidity><young adult><young adulthood>