Summary: This study compared perinatal mental health outcomes for low-income women in states that expanded Medicaid with states that did not. They found a substantial drop in pre-pregnancy depression, which they attribute to better diagnosis and treatment and/or reduced financial worry. Health coverage reduces morbidity.
Medicaid Expansion Associated with Some Improvements in Perinatal Mental Health
By CE Margerison et al.
Poor perinatal mental health is a common pregnancy-related morbidity with potentially serious impacts that extend beyond the individual to their family. A possibly contributing factor to poor perinatal mental health is discontinuity in health insurance coverage, which is particularly important among low-income people. We examined impacts of Medicaid expansion on prepregnancy depression screening and self-reported depression and postpartum depressive symptoms and well-being among low-income people giving birth. Medicaid expansion was associated with a 16 percent decline in self-reported prepregnancy depression but was not associated with postpartum depressive symptoms or well-being. Associations between Medicaid expansion and prepregnancy mental health measures increased with time since expansion. Expanding health insurance coverage to low-income people before pregnancy may improve perinatal mental health.
We used a difference-in-differences study design, which estimates the change in outcomes post–Medicaid expansion compared with preexpansion among pregnant people in expansion states compared with those in nonexpansion states. … data from the Pregnancy Risk Assessment Monitoring System (PRAMS) phases 7 (2012–15) and 8 (2016–18).
Potential mechanisms by which health insurance may improve mental health include increased diagnosis and treatment (whether pharmaceutical or behavioral) or reduced financial distress.
Comment by: Isabel Ostrer
Poor perinatal mental health affects between 13 and 25 percent of people who have recently given birth. The number is even high among those with lower incomes. Unfortunately, it is precisely this group that is at greatest risk of lacking health insurance coverage because of our convoluted, multi-payer health care system.
Although all low-income (defined as those earning < 133% of the federal poverty line) pregnant Americans are required to have access to health insurance, this same benefit doesn’t apply pre-conception in states that did not expand Medicaid. In fact, in the remaining 12 Medicaid non-expansion states, nonnpregnant, nondisabled adults without dependents must earn exactly $0 to qualify for Medicaid coverage. In many cases, the insurance that applies during pregnancy expires 60 days postpartum.
This study found, unsurprisingly, that Medicaid expansion was associated with a 22% increase in prepregnancy Medicaid insurance. But moreover, it found a significant decrease – 16% – in self-reported prepregnancy depression.
Health insurance coverage leads to improved mental health. This is particularly important for new parents. But all Americans deserve health insurance and the positive physical and mental health benefits that come with it. Single payer is the most straightforward way to achieve universal coverage.