Women experience high rates of health insurance ‘churn’ before and after childbirth

Many women, particularly those covered under Medicaid or the Children’s Health Insurance Program, may lose access to prenatal and postpartum care

A high percentage of women in the U.S. move in and out of health insurance coverage — sometimes referred to as ‘churn’ — in the months before and after childbirth, according to a new study from Harvard T.H. Chan School of Public Health. Low-income women experience the brunt of these insurance disruptions, which cause coverage gaps that can lead to adverse health outcomes.

The study is the first to use national data to look at month-to-month health insurance coverage for women during and after pregnancy. It appears in the April 2017 issue of Health Affairs.

“Ideally, every woman would have access to coverage not only for prenatal care and delivery, but also for preconception and extended postpartum care. We find there is much more work to be done to ensure that women retain continuous coverage for services we know are critical for reducing adverse birth outcomes and supporting the health of moms and babies,” said Jamie Daw, the study’s lead author and a doctoral student in health policy at Harvard University.

The study analyzed data from 2005–13 from more than 2,700 women surveyed by the nationally representative Medical Expenditure Panel Survey.

The researchers found the highest rates of coverage at delivery. But that coverage masked considerable churning during the prenatal and postpartum months — especially for women who had coverage through Medicaid or the Children’s Health Insurance Program (CHIP) in the month of delivery.