Insurance churn, or moving between different insurance plans or between insurance and uninsurance, is common during the perinatal period. We used survey data from the 2012-17 Pregnancy Risk Assessment Monitoring System to estimate the impact of Affordable Care Act-related state Medicaid expansions on continuity of insurance coverage for low-income women across three time points: preconception, delivery, and postpartum. We found that Medicaid expansion resulted in a 10.1-percentage-point decrease in churning between insurance and uninsurance, representing a 28 percent decrease from the prepolicy baseline in expansion states. This decrease was driven by a 5.8-percentage-point increase in the proportion of women who were continuously insured and a 4.2-percentage-point increase in churning between Medicaid and private insurance. Medicaid expansion improved insurance continuity in the perinatal period for low-income women, which may improve the quality of perinatal health care, but it also increased churning between public and private health insurance.
Keywords: Affordable Care Act; Children's health; Churn; Continuity of care; Health policy; Insurance coverage and benefits; Low income; Maternal health; Medicaid; Medicaid expansion; PRIVATE HEALTH INSURANCE; State Medicaid; Uninsured; Women's health; access to care; health insurance.