Persistent Health Effects of Early Life Medicaid Coverage

A large and growing literature has documented the link between the fetal environment and later life health and achievement. However, relatively few studies have evaluated whether public policies designed to improve fetal health have persistent later life effects. Our project is the first to evaluate the long-term consequences of improved in utero health that resulted from a widespread increase in prenatal coverage through the Medicaid program from 1979 to 1995. While the effect of these expansions on fetal and infant health is well-documented (e.g. Currie and Gruber 1996), little is known about whether these improvements had effects that persisted into adulthood.

The purpose of this study is to assess how the rapid expansion of Medicaid benefits to pregnant women in the 1980s and early 1990s affected later-life health outcomes for individuals whose mothers gained coverage. Our study will link two well-developed literatures: the epidemiologic literature on the “fetal origins hypothesis” and the economic literature on the effect of prenatal Medicaid coverage on the utilization of services and birth outcomes. We hypothesize that the provision of Medicaid benefits, and the accompanying increase in prenatal care utilization and improvement in birth weight, have lasting effects on individuals who were in utero during the expansions.

Using national survey and state hospital discharge and Emergency Department databases, we test whether expansions in eligibility for Medicaid prenatal care affected adult health outcomes for those whose mothers were pregnant during the expansions. Among the outcomes we consider are adult BMI, diabetes, hypertension, self-reported health and the utilization of health services such as hospitalizations. Following the literature, we rely on a simulated eligibility approach that constructs a measure of generosity of state eligibility rules to instrument for the fraction of women eligible for Medicaid prenatal coverage. We link these changes in eligibility rules over time with the state and year of birth of adults to measure their exposure to the Medicaid coverage expansions. Because states with more generous prenatal coverage may also have better coverage for children at older ages, we also control for public health insurance eligibility at other ages during childhood. In addition, our regression models control for individual characteristics, including age, race, sex, citizenship status, ethnicity and family structure, as well as state and year fixed effects.

Our preliminary findings indicate improvements in health outcomes for adults benefiting from the Medicaid prenatal expansions, including declines in obesity, number of poor physical health days, and visits to the emergency room. These findings suggest that expansions in Medicaid prenatal coverage had long-term benefits for the health of the next generation.