The dependent coverage provision of the Affordable Care Act (ACA) requires private health insurers to allow young adults to remain on their parent's insurance plan until age 26. To determine the provision's effects on pregnant women, researchers compared 1,379,005 live births among women ages 24 to 25 and 1,551,192 live births among women ages 27 to 28 before and after the ACA's enactment. Nearly one-third of births in the United States are to women ages 19 to 25.

The study examined three parameters. The first was insurance status, which was determined according to payment for birth-Medicaid, private insurance, or self-pay. The researchers acknowledged that payment for birth does not necessarily reflect coverage status before and during pregnancy, as most women with private insurance at delivery have been insured throughout pregnancy, while those whose births are reimbursed by Medicaid often just acquire coverage during pregnancy or at delivery. But they note that estimates of payment for birth in their study "likely understate the role the policy played in increasing preconception and postconception coverage and the number of months women were insured during pregnancy."

The second parameter was prenatal care-classified as early prenatal care (a first visit in the first trimester), and adequate prenatal care (a first trimester visit and at least 80% of expected visits thereafter). The third parameter was birth outcomes: cesarean delivery, premature birth (less than 37 weeks), low birth weight (less than 2500 g), and admission to the neonatal ICU (NICU). The period before the enactment was limited to the year 2009, while the period after the enactment stretched from 2011 to 2013. Results were stratified by marital status: married women were more likely to be privately insured through a spouse and less likely to receive insurance through a parental plan.

The ACA's dependent coverage provision was associated with increased private insurance payment for birth, decreased Medicaid and self-payment, increased prenatal care, and a modest drop in premature births. However, rates of cesarean delivery, low birth weight, or NICU admission were not significantly altered. In stratified analyses, changes in payment for birth, prenatal care, and premature birth were concentrated among unmarried women. Unmarried women experienced a 20% relative increase in private insurance coverage compared with married women who, likely because of coverage through their spouse, saw little change.-Dalia Sofer

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