Introduction
The purpose of this study is to examine year-by-year effects of the 2014 Affordable
Care Act Medicaid expansion on infant mortality by race and ethnicity over the first
6 years.
Methods
Publicly available 2011–2019 Multiple Cause of Death data were extracted in October
and analyzed by November 2021. A difference-in-differences event-study design compared
infant mortality changes in states that expanded in 2014 to nonexpansion states.
Results
In the main model, the 2014 Medicaid expansions were associated with a statistically
significant decline in Black infants’ mortality in 2018 and 2019 by 1.19 (95% CI=
–2.27, –0.12) and 1.35 (95% CI= –2.45, –0.26) deaths per 1,000 live births, respectively.
There was also a decline in mortality for Hispanic infants in 2015–2019, including
by 0.8 (95% CI= –1.25, –0.36) and 1.28 (95% CI= –1.88, –0.68) deaths per 1,000 live
births in 2015 and 2019, respectively. Overall, infant mortality declined by 0.37
(95% CI= –0.70, –0.05) deaths per 1,000 live births in 2019.
Conclusions
The study adds evidence on the association of the Affordable Care Act Medicaid expansions
with a decline in mortality of Black and Hispanic infants. The findings shed light
on the importance of examining year-by-year effects over multiple years.
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Publication history
Published online: December 05, 2022
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
