Most publicly-insured pregnant Texas women lost coverage during the year after delivery, finds new study

Almost 90% of Texas women whose pregnancies were covered by public insurance were uninsured at some point in the first year after delivery, according to a new study from researchers at The University of Texas at Austin. This phenomenon of "insurance churn" can leave women with limited access to care at a time when they need it.

In the new study, which was selected as the Editor's Choice for the March/April issue of Women's Health Issues, authors followed 1,498 postpartum Texans with pregnancies covered by public insurance. The researchers, who are affiliated with the Texas Policy Evaluation Project (TxPEP), found that many women lost insurance coverage and encountered difficulties in obtaining care for a range of health conditions.

"Discussions around postpartum healthcare must focus on the big picture," said Lauren Thaxton, assistant professor of Women's Health at Dell Medical School at The University of Texas at Austin and researcher with TxPEP. "Stable insurance coverage throughout a person's life—including the crucial periods before, during, and in the year after delivery—can increase general health and wellness and allow any issues to be addressed by a provider before they become critical."

The researchers used data from the Texas Postpartum Contraception Study, which recruited women who gave birth with coverage from Medicaid or the Children's Health Insurance Program (CHIP) at one of eight participating Texas hospitals between 2014 and 2016. They examined responses to surveys administered three, six, and 12 months after childbirth. They found that 77% of participants were uninsured at three months postpartum, and most had not acquired coverage by the end of the year.

Participants' responses to open-ended survey questions indicated a variety of health concerns in the postpartum period and barriers to care, the authors reported. Conditions described by uninsured women included gallstones, unexplained vomiting and headaches, and symptoms of anxiety and depression. "If an end result of insurance churn is that women with lower incomes living with chronic conditions only have access to treatment when pregnant, postpartum women may experience severe (and preventable) complications," wrote lead author Elizabeth Ela and her co-authors.

"This study makes an important contribution by not only documenting postpartum insurance loss, but reporting on the kinds of health needs that such insurance loss can make it harder to address," said Amita Vyas, Editor-in-Chief of Women's Health Issues and associate professor of prevention and community health at Milken Institute SPH.