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

Abstract

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.