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; 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.

项目摘要/摘要 及时，高质量的产前护理与改善儿童和孕产妇的健康成果有关，以及 怀孕期间的全面健康保险促进了获得产前护理的机会。负担得起的 护理法（ACA）包括产前和产妇护理是必须是十个基本健康益处之一 涵盖市场计划（即个人的商业保险计划）。 ACA市场是 不符合医疗补助或雇主的孕妇的健康保险来源 - 赞助保险。但是，当前的市场入学政策使入学具有挑战性 怀孕早期的市场计划，这可能会对获得产前的不利影响 护理和儿童和孕产妇的健康成果。 所有市场计划的年度开放式入学期（OEP）从11月左右到 一月。个人只能通过特殊 入学期（SEP），这是合格生活事件后的有限时间窗口（例如，保险丢失 覆盖范围或家庭变化[包括分娩]）。 ACA不包括怀孕作为预选赛 SEP市场覆盖范围的活动。因此，在OEP之外怀孕的人必须 延迟市场注册，直到他们有合格的SEP资格事件，下一个年度OEP或给予 出生。近年来，美国六个州颁布了政策，将怀孕纳入9月的市场 合格事件，这意味着这些州的人们可以在成为市场计划时加入市场计划 孕。我们假设该政策有助于妊娠早期市场入学率，这增加了 市场上孕妇的百分比是及时，高质量的产前护理并改善的百分比 市场参与者的母亲和婴儿健康成果。 我们的研究将利用由国家级别差异在SEP资格中创建的自然实验 估计将怀孕作为SEP资格事件的政策影响的规则。具体来说，我们会的 首先（AIM 1）描述市场在提供健康保险范围和访问权限的作用 对孕妇的产前护理（AIM 1）。然后，我们将使用强大的准实验设计来评估 在（AIM 2）及时的产前护理和（AIM 3）婴儿的影响（AIM 2）婴儿的影响（AIM 2）婴儿的影响 和入学市场的孕妇的孕产妇健康成果。我们将使用全付款人索赔数据 来自2014 - 2019年的纽约（干预状态）和马萨诸塞州（控制状态），这提供了许多 在市场上对孕妇的事先研究中使用的数据优于数据。我们的发现 研究将为州级和联邦级别的决策者提供关键和及时的信息，以确保 （i）没有其他保险选择的孕妇可以访问（i），以及（ii） 有效地改善产前护理，最终是儿童和孕产妇的健康成果。