Women In The United States Experience High Rates Of Coverage 'Churn' In Months Before And After Childbirth

Health Aff (Millwood). 2017 Apr 1;36(4):598-606. doi: 10.1377/hlthaff.2016.1241.


Insurance transitions-sometimes referred to as "churn"-before and after childbirth can adversely affect the continuity and quality of care. Yet little is known about coverage patterns and changes for women giving birth in the United States. Using nationally representative survey data for the period 2005-13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100-185 percent of the poverty level. To minimize the adverse effects of coverage disruptions, states should consider policies that promote the continuity of coverage for childbearing women, particularly those with pregnancy-related Medicaid eligibility.

Keywords: Health Reform; Insurance Coverage < Insurance; Maternal And Child Health.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Eligibility Determination*
  • Female
  • Health Services Accessibility
  • Humans
  • Income / statistics & numerical data
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health / statistics & numerical data*
  • Medicaid / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Parturition*
  • Poverty / statistics & numerical data
  • Pregnancy
  • Surveys and Questionnaires
  • United States

Grant support