ArticlePublic health reports (Washington, D.C. : 1974)2026
Medicaid Expansion and Rural-Urban Disparities in Postpartum Medicaid Coverage.
Article in Public health reports (Washington, D.C. : 1974), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveRural residents experience higher rates of postpartum uninsurance than their urban counterparts, contributing to rural-urban disparities in maternal health outcomes. We examined how Medicaid expansion under the Affordable Care Act affected rural-urban disparities in the rates of postpartum health insurance coverage among low-income women.
methodsWe used nationally representative data from the 2010-2012 and 2015-2019 American Community Survey to compare rates of postpartum health insurance coverage among low-income women in states that expanded Medicaid and states that did not expand Medicaid (difference-in-differences analysis). We analyzed changes in disparities in postpartum health insurance coverage between women living in rural areas and women living in urban areas (difference-in-difference-in-differences analysis).
resultsWomen living in rural areas had the greatest increases in postpartum health insurance coverage, with a 17.0 percentage-point increase in states that expanded Medicaid (95% CI, 13.9-20.2) and an 11.5 percentage-point increase in states that did not expand Medicaid (95% CI, 9.2-13.8). Any postpartum health insurance coverage among rural residents relative to urban residents increased by 4.8 percentage points (95% CI, 2.0-7.7) in states that expanded Medicaid compared with states that did not. We observed similar trends for Medicaid postpartum health insurance coverage specifically.
conclusionsRural women had greater increases in postpartum health insurance coverage relative to urban women following Medicaid expansion, thereby reducing geographic disparities in health insurance coverage during the postpartum period. Future research should focus on whether disproportionate gains in health insurance coverage for rural communities led to increased access to care during the postpartum period.
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