蜜桃影视

One sentence can hold a lot of heartache. This one, for instance:

Babies born to mothers on Medicaid died at almost twice the rate of babies born to mothers with private health insurance.

That may read like an indictment of the federal Medicaid program, but it isn鈥檛. Rather, it鈥檚 a reflection of the program鈥檚 limitations, the complicated circumstances of mothers experiencing poverty, and sometimes a simple matter of geography.

鈥淢edicaid is fantastic and undoubtedly has improved outcomes for mothers and babies. But even though it鈥檚 beneficial, it isn鈥檛 as good as private insurance,鈥� says Dr. Colm P. Travers, neonatologist and assistant professor of pediatrics for the University of Alabama at Birmingham School of Medicine. 鈥淏abies don鈥檛 get to choose who their parents are, how much money their parents make or what they do for a living. The baby shouldn鈥檛 suffer because of their parents鈥� socioeconomic status.鈥�

Travers led a recent study on how insurance status relates to infant outcomes in the U.S. The study, 鈥�,鈥� was published in the October 2023 issue of JAMA Network Open. The study used data from the birth and infant death records database of the Centers for Disease Control and Prevention (CDC) from 2017 to 2020. Researchers analyzed data of more than 13 million infants; 54% born to mothers with private insurance and 46% to mothers with Medicaid. The study found that those with private insurance had a significantly lower risk of infant mortality 鈥� almost half the rate of mothers with Medicaid 鈥� as well as a lower risk of low birth weight, vaginal breech delivery and preterm birth. They were more likely to receive prenatal care in the first trimester compared with those with Medicaid.

Prenatal care is foundational for positive outcomes because the first trimester is such a crucial time for both mother and baby, says the study鈥檚 first author, Desalyn Johnson, a soon-to-be MD from the University of Alabama at Birmingham.

鈥淔rom a biological standpoint for the fetus, that first trimester is when organogenesis occurs,鈥� Johnson says. 鈥淭he other two trimesters see more growth of the body, but the first trimester is when the heart, the lungs 鈥� all the organs 鈥� are formed. It鈥檚 also a time for recognizing the mother鈥檚 baseline risk factors that might put a pregnancy at risk, such as high blood pressure or diabetes. You really want mothers to have access to prenatal care at that critical time.鈥�

Presumed Eligible

Because the prenatal period is so crucial, many states provide presumptive eligibility for low-income mothers, meaning that they can start prenatal care as early as possible in their pregnancy. General guidelines for Medicaid eligibility are set by the federal government, but each state sets up their own requirements for eligibility, which differ from state to state. In states that don鈥檛 allow presumptive eligibility, the process for approval can send applicants through an administrative tangle that takes weeks and involves multiple steps to navigate the bureaucracy 鈥� at a time when the clock is ticking for both mother and fetus.

鈥淥ne of the big differences we found in infant outcomes was that the Medicaid population had delayed or inadequate prenatal care, possibly because of the process they have to go through before they can even get an appointment for their first prenatal visit. That can mean by the time they get approved, they鈥檙e delayed in their prenatal care, or they haven鈥檛 received adequate care in those first months. They鈥檙e already behind,鈥� she says.

Sometimes whether an expectant mother can receive adequate care boils down to whether she can get to it, Johnson adds.

鈥淗ere in Alabama, a lot of our population is very rural,鈥� she says. 鈥淪ome must travel great distances to receive healthcare. When you鈥檙e trying to access Medicaid services, it adds to the barrier when you have to go to this county clerk or that building to fill out paperwork and then back and forth. It can be difficult.

鈥淎 lot of times, researchers look at urban health, which is very important, but we also need to consider this rural aspect, especially in the Southeast.鈥�

Nowhere to Go

Once a pregnant person does get signed up for Medicaid, there is no guarantee that they will be able to find a health professional to care for them or their babies. According to a research letter published in JAMA Network Open, 鈥�,鈥� in 2020, the number of general pediatricians in the entire U.S. was 56,800. Only 2,900 of these doctors worked in rural counties; 86 worked in completely rural counties, which the defines as a county with open countryside, fewer than 500 people per square mile and no towns with more than 2,500 population. Nationwide, 1,391 counties had no pediatrician; 1,156 of these were rural counties; 331 counties had neither general pediatricians nor family medicine physicians (FMPs).

The March of Dimes鈥� 2022 report, 鈥�,鈥� finds that about 36% of all U.S. counties have no maternity care, whether obstetric providers, certified nurse midwives, or hospitals or birth centers offering obstetric care 鈥� a number that appears to be growing. Maternity care deserts are associated with a lack of adequate prenatal care during pregnancy, treatment of pregnancy complications and an increased risk of maternal death. More than 2.2 million U.S. women of childbearing age 15 to 44 live in maternity care deserts.

Among all highly industrialized countries, the March of Dimes report states, the U.S. is considered one of the most dangerous developed nations in the world in which to give birth.

, counties with neither general pediatricians nor FMPs were more likely to have higher percentage of non-Hispanic Black children, higher child uninsured rates, higher child poverty levels and fewer children enrolled in K-12. The issue of health professional deserts is so pervasive now in the U.S. it even gets its own acronym, HPSA (health professional shortage areas).

This shortage helps explain 鈥� though not entirely 鈥� why babies, especially post-neonatal intensive care unit (NICU) babies, born under Medicaid don鈥檛 receive the same level of postnatal care, such as oxygen monitors and ventilators, as babies born to privately insured mothers. The babies born on Medicaid also face increased risk of dying from trauma, accidents, and 鈥� a serious neonatal illness most common in premature babies, especially NICU babies who don鈥檛 get human milk.

Lifesaving Alternatives

These negative outcomes don鈥檛 have to be assumed for mothers living in poverty, the researchers say. Multiple studies have shown that expanding Medicaid prenatal care can dramatically improve things for both mothers and babies. For example, found that expanding Medicaid to cover prenatal care for undocumented immigrant women in Oregon was associated with more prenatal care visits and improved care, a reduction in the number of babies born with extremely low birth weight, and lower infant mortality rate. Additionally, the mothers鈥� access to prenatal care was associated with an increased number of well child visits and increased rates of recommended screening and vaccines during the child鈥檚 first year.

A study of Medicaid-sponsored provided strong evidence that the program improves the lives and health of mothers and babies. A team of nurses, social workers and other specialists work with the pregnant person鈥檚 doctor and local providers to care for mother and child throughout pregnancy and the child鈥檚 first year, including a well-regarded . The study found that enrollment in the program significantly reduced the odds of babies dying within their first year.

Ruling Out Race

Aware of important racial disparities in infant outcomes in the U.S., researchers adjusted their health insurance study for race, so the results reflected the difference between mothers on Medicaid and mothers with private insurance, not race-based differences.

鈥淩ace is largely a social construct,鈥� Travers says. 鈥淚ncreasingly, medical and genomic studies are showing that there is little basis for race-based medicine in the U.S. In this study, we adjusted for the effect of race in our analysis, not to eliminate race, but to try to take it out of the equation. We purposely looked at insurance and adjusted for race so that we could get at the question of socioeconomic status and insurance specifically.鈥�

For example, a recent from the National Institute of Child Health and Human Development found that newborns of Black patients had the worst perinatal outcomes. But once the study adjusted for insurance status, the difference was no longer significant.

The researchers also adjusted for sex of the newborn, maternal pregnancy risk factors, education level and tobacco use to analyze the differences between the two groups. The difference boiled down to who had the better health care. In other words, infant mortality outcomes are not fully explained by those external factors but are associated with the mother鈥檚 socioeconomic status, and access to insurance and adequate health care. Populations that are entirely self-pay, such as undocumented immigrants, may have even poorer outcomes than Medicaid patients 鈥攁 subject for future study, the researchers say.

The results reflected in these studies don鈥檛 point to Medicaid鈥檚 failure but to the work remaining to be done to ensure that pregnant women of all socioeconomic circumstances receive the timely, adequate care they and their babies need.

鈥淭he draw of pediatrics for us as doctors is that when we鈥檙e working with children, we can lay the foundation for them to have healthy and successful lives,鈥� Johnson says. 鈥淏ut if you don鈥檛 lay that foundation in the dawn of life, it can have repercussions for their entire lifespan. 聽鈥淲e鈥檝e now documented that, yes, these findings are what we expected. The next steps now are to decide how we as physicians, as policymakers, can address these issues and improve the outcomes for these babies.鈥�

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Further Reading

: In 2020, 42% of all births in the U.S. were covered by Medicaid. About one in nine women of childbearing age (11.6%) in the U.S. was uninsured. About one in 18 children younger than 19 was uninsured.

An interactive map showing which of the states have adopted Medicaid expansion coverage for nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,783 for an individual in 2024) and the 10 states that have not done so.

This story originally published on Early Learning Nation and is now archived on 蜜桃影视. Learn more here.