Affordable Care Act and Access to Care: An Examination of Over 3 Million North Carolina Birth Outcomes and Hospital Choices

Abstract

The Patient Protection and Affordable Care Act (ACA) is the comprehensive health care reform law that was enacted in March 2010 under the Obama administration. In 2014, the ACA was implemented in North Carolina. The purpose of this study is to examine the impact of the ACA on birth outcomes of expectant mothers. To do this, a difference in difference estimation approach was used to compare the pre-intervention, 1996-2013, and post-intervention, 2014-2017, groups of expectant mothers in North Carolina. The results from this analysis show that the Affordable Care Act decreased birth weight by 29.482 grams and gestation length by 0.0858 weeks and increased the likelihood of a preterm birth by 0.9% and a low birth weight by 0.59%. An increase in 10 minutes of driving time to the birth hospital results in weight in grams decreases by 19.14 grams and gestation length decreases by 3/25 of a week. This also results in an increased risk of low birth weight, very low birth weight, preterm births, and extreme preterm births. The coefficients on the interaction term for preterm and extreme preterm births are negative and significant at the 10% level suggesting the passing of the ACA may improve some birth outcomes for pregnant women who are geographically distant from their birthing hospital. However, the extremely small magnitudes suggest that these health benefits are minimal. These findings highlight that alleviating financial barriers to care neither improves or inhibits reproductive health only to the extent that geographic barriers to care are also surmountable. Implications for healthcare policy are that competing barriers to care (e.g. financial and geographic) must be considered jointly and that the current trend in rural maternity ward closures may undermine the effectiveness of the concurrent trend in Medicaid expansion.