Effects of Recent Medicaid Expansions on Infant Mortality by Race and Ethnicity

  • Joanne Constantin
    Address correspondence to: Joanne Constantin, MPH, Department of Health Management and Policy, College of Public Health, University of Iowa, 145 North Riverside Drive, 100 College of Public Health Building, Room N273, Iowa City IA 52242.
    Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
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  • George L. Wehby
    Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
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Published:December 05, 2022DOI:


      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.


      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.


      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.


      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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