title: Women In The United States Experience High Rates Of Coverage 'Churn' In Months Before And After Childbirth.
abstract: Insurance transitions-sometimes referred to as "churn"-before and after childbirth can adversely affect the continuity and quality of care. Yet little is known about coverage patterns and changes for women giving birth in the United States. Using nationally representative survey data for the period 2005-13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100-185 percent of the poverty level. To minimize the adverse effects of coverage disruptions, states should consider policies that promote the continuity of coverage for childbearing women, particularly those with pregnancy-related Medicaid eligibility.
authors.affiliation: Jamie R. Daw (jdaw@fas.harvard.edu) is a PhD candidate in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Jamie R
authors.initials: JR
authors.lastname: Daw
authors.affiliation: Laura A. Hatfield is an assistant professor in the Department of Health Care Policy at Harvard Medical School.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hatfield
authors.affiliation: Katherine Swartz is a professor in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, in Boston.
authors.forename: Katherine
authors.initials: K
authors.lastname: Swartz
authors.affiliation: Benjamin D. Sommers is an associate professor of health policy and economics in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
mesh_terms: D004608:Eligibility Determination; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D036801:Parturition; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014481:United States
keywords: Health Reform; Insurance Coverage < Insurance; Maternal And Child Health