Heterogeneous Effects of Health Insurance on Birth Related Outcomes : Unpacking Compositional vs. Direct Changes

When women of childbearing age gain health insurance, we expect their birth outcomes to improve, but comparing births that occur before and after policy changes may confound two separate impacts of coverage. For one, health insurance could affect who gives birth, through reduced costs of contraception. Health insurance could also directly improve maternal and child health among those who give birth, through additional prenatal resources. We address this question using the Affordable Care Act young adult provision, comparing birth related outcomes for those aged 24-25 years after the law, to outcomes among older young adults. We show that since the law subsidized contraceptives mainly among higher socioeconomic groups, the composition of mothers shifted towards less advantaged groups. Accounting for this shift, we find evidence of direct improvements in prenatal care and pregnancy-related health (reduced gestational diabetes and hypertension)