The Impact of Including Pregnancy as a Qualifying Life Event for Marketplace Special Enrollment on Child and Maternal Health

将怀孕作为市场特殊招生的合格生活事件对儿童和孕产妇健康的影响

• 批准号: 10636398
• 负责人: Laura Faden Garabedian
• 金额: $ 55.24万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-06 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636398
• 关键词: Affordable Care Act; Anatomy; Birth; Caring; Censuses; Cessation of life; Characteristics; Child Health; Childbirth; Classification; Comprehensive Health Insurances; Data; Diagnosis; Eligibility Determination; Enrollment; Event; Family; Gestational Diabetes; Guidelines; Health; Health Benefit; Health Insurance; Health Services Accessibility; Healthcare; Hospitalization; Household; Improve Access; Individual; Infant; Infant Health; Insurance; Insurance Carriers; Insurance Coverage; Intervention; Job loss; Laws; Length of Stay; Life; Link; Low Birth Weight Infant; Marriage; Massachusetts; Maternal Health; Measures; Medicaid; Methods; Mothers; Natural experiment; Neighborhoods; New York; Outcome; Perinatal; Persons; Policies; Policy Maker; Policy Making; Postpartum Depression; Pre-Eclampsia; Pregnancy; Premature Birth; Prenatal care; Qualifying; Quasi-experiment; Recommendation; Reporting; Research; Role; Source; Special Event; Surveys; Time; Ultrasonography; Uninsured; Vaccines; Variant; adverse outcome; care systems; design; falls; health care service utilization; hospital readmission; improved; infant outcome; insurance plan; member; novel; postnatal period; pregnant; prenatal; socioeconomics

Project Summary/Abstract Timely, high-quality prenatal care is associated with improved child and maternal health outcomes, and comprehensive health insurance coverage during pregnancy facilitates access to prenatal care. The Affordable Care Act (ACA) included prenatal and maternity care as one of the ten essential health benefits that must be covered in Marketplace plans (i.e., commercial insurance plans for individuals). ACA Marketplaces are an important source of health insurance for pregnant people who are not eligible for Medicaid or employer- sponsored insurance. However, current Marketplace enrollment policies make it challenging to enroll in a Marketplace plan early in pregnancy, which may have adverse consequences for access to prenatal care and child and maternal health outcomes. All Marketplace plans have an annual open enrollment period (OEP) from approximately November to January. An individual can enroll in a Marketplace plan outside of the annual OEP only through a special enrollment period (SEP), which is a limited time window after a qualifying life event (e.g., loss of insurance coverage, or household change [including childbirth]). The ACA did not include pregnancy as a qualifying event for SEP Marketplace coverage. Therefore, people who become pregnant outside of the OEP must delay Marketplace enrollment until they have an eligible SEP-qualifying event, the next annual OEP, or give birth. In recent years, six U.S. states have enacted policy to include pregnancy as a Marketplace SEP- qualifying event, meaning that people in these states can enroll in a Marketplace plan when they become pregnant. We hypothesize that this policy facilitates Marketplace enrollment earlier in pregnancy, increases the percent of pregnant people on the Marketplace who receive timely, high-quality prenatal care, and improves maternal and infant health outcomes for Marketplace enrollees. Our study will exploit a natural experiment created by state-level variation in Marketplace SEP eligibility rules to estimate the impact of a policy to include pregnancy as a SEP-qualifying event. Specifically, we will first (Aim 1) describe the role of the Marketplace in providing health insurance coverage and access to prenatal care for pregnant people (Aim 1). We will then use a robust quasi-experimental design to evaluate the impact of including pregnancy as an SEP-qualifying event on (Aim 2) timely prenatal care and (Aim 3) infant and maternal health outcomes for pregnant people who enroll in Marketplace. We will use all-payer claims data from New York (intervention state) and Massachusetts (control state) from 2014-2019, which provide many advantages over data used in prior research of pregnant people on the Marketplace. The findings from our study will provide critical and timely information for state-level and federal-level policy-makers to ensure that Marketplace coverage is (i) accessible for pregnant people without other insurance coverage options, and (ii) effective in improving prenatal care and, ultimately, child and maternal health outcomes.

项目概要/摘要 及时、高质量的产前护理与改善儿童和孕产妇健康结果相关，并且 怀孕期间全面的健康保险有助于获得产前护理。价格实惠 《护理法案》(ACA) 将产前和产妇护理列为必须纳入的十项基本健康福利之一 涵盖在市场计划（即个人商业保险计划）中。 ACA 市场是 对于不符合医疗补助或雇主资格的孕妇来说，这是健康保险的重要来源- 赞助保险。然而，当前的市场注册政策使得注册具有挑战性 怀孕早期的市场计划，这可能会对获得产前服务产生不利影响 护理以及儿童和孕产妇健康结果。 所有 Marketplace 计划都有一个年度开放注册期 (OEP)，大约从 11 月到 一月。个人只能通过特殊的方式在年度 OEP 之外注册 Marketplace 计划 注册期 (SEP)，这是合格生活事件（例如，失去保险）之后的有限时间窗口 保险范围或家庭变化[包括分娩]）。 ACA 并未将怀孕列为合格条件 SEP 市场报道活动。因此，在 OEP 之外怀孕的人必须 推迟市场注册，直到他们有符合条件的 SEP 资格活动、下一个年度 OEP，或者给予 出生。近年来，美国六个州颁布了政策，将怀孕纳入市场 SEP- 资格活动，这意味着这些州的人们可以在成为市场计划时注册 孕。我们假设这项政策有利于怀孕早期的市场注册，增加了 市场上接受及时、高质量产前护理并改善的孕妇的百分比 市场参与者的孕产妇和婴儿健康结果。 我们的研究将利用市场 SEP 资格的州级差异创建的自然实验 规则来估计将怀孕纳入 SEP 合格事件的政策的影响。具体来说，我们将 首先（目标 1）描述市场在提供健康保险覆盖和获得医疗保险方面的作用 孕妇的产前护理（目标 1）。然后，我们将使用稳健的准实验设计来评估 将怀孕作为 SEP 合格事件对（目标 2）及时产前护理和（目标 3）婴儿的影响 以及注册 Marketplace 的孕妇的孕产妇健康结果。我们将使用所有付款人的索赔数据 2014 年至 2019 年，纽约州（干预州）和马萨诸塞州（控制州）提供了许多 与市场上之前孕妇研究中使用的数据相比具有优势。我们的调查结果 研究将为州级和联邦级决策者提供关键和及时的信息，以确保 市场承保范围 (i) 适合没有其他保险承保选项的孕妇，并且 (ii) 有效改善产前护理，并最终改善儿童和孕产妇健康结果。