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News
Expanding Medicaid got more moms covered — but didn't make delivery safer. A large retrospective study found that the 2014 ACA Medicaid expansion increased the share of deliveries paid by Medicaid but had no significant effect on severe maternal morbidity (SMM) rates during delivery hospitalizations. The findings were consistent across racial and ethnic subgroups, suggesting insurance coverage alone isn't enough to move the needle on maternal health outcomes.
More coverage, same risk. A large retrospective study published in Obstetrics and Gynecology found that the 2014 Medicaid expansion under the Affordable Care Act — while successfully increasing insurance coverage for delivering mothers — did not lead to a statistically significant reduction in severe maternal morbidity (SMM) during delivery hospitalizations.
Researchers analyzed over 11.9 million delivery hospitalizations across 26 states from 2010 to 2018, comparing 16 states that expanded Medicaid in January 2014 with 10 that did not. Despite a 5.2-percentage-point increase in the proportion of deliveries paid by Medicaid in expansion states, SMM rates remained unchanged — a finding that held across racial and ethnic subgroups.
By the Numbers
Why it matters: Insurance coverage is a critical first step, but this study signals that access alone isn't sufficient to improve maternal health outcomes. Clinicians and policymakers may need to look beyond coverage expansion — toward targeted clinical interventions and systemic care improvements — to meaningfully reduce maternal morbidity.
