Journal of Population Economics

, Volume 32, Issue 2, pp 419–453 | Cite as

Does public insurance coverage for pregnant women affect prenatal health behaviors?

  • Dhaval M. DaveEmail author
  • Robert Kaestner
  • George L. Wehby
Original Paper


Despite plausible mechanisms, little research has evaluated potential changes in health behaviors in response to expansions in public insurance coverage of the 1980s and 1990s targeted at low-income families. In this paper, we provide the first national study of the effects of Medicaid expansions on health behaviors for pregnant women, which is a group of particular interest given evidence of the importance of prenatal health to later life outcomes. In doing so, we also add to the sparse literature on ex ante moral hazard, which is nearly always mentioned as a theoretical consequence of health insurance, though relatively few empirical studies have assessed its importance. We exploit exogenous variation from the Medicaid income eligibility expansions for pregnant women during late-1980s through mid-1990s to examine the effects of these policy changes on smoking, weight gain, and other maternal health indicators. We find that the 13 percentage point increase in Medicaid eligibility during the study period was associated with approximately a 3% increase in smoking and a small increase in pregnancy weight gain for most of the sample. The increase in smoking, which is a significant cause of poor infant health, may partly explain why Medicaid expansions have not been associated with substantial improvement in infant health.


Medicaid Insurance Moral hazard Health Smoking Weight Prenatal care Infant health 

JEL Classification

D1 H0 I12 I13 I18 



The authors would like to thank Briggs Depew, Brad Humphreys, Christina Marsh, Joshua Pinkston, Jennifer Trudeau, Wen You, Joshua Graff Zivin, seminar participants at Montana State University, University of Gothenburg, and the Danish Institute for Local and Regional Government Research, and the anonymous referees for helpful comments and suggestions.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Dhaval M. Dave
    • 1
    • 2
    • 3
    Email author
  • Robert Kaestner
    • 2
    • 4
  • George L. Wehby
    • 2
    • 5
  1. 1.Department of EconomicsBentley UniversityWalthamUSA
  2. 2.National Bureau of Economic Research (NBER)CambridgeUSA
  3. 3.Institute of Labor Economics (IZA)BonnGermany
  4. 4.Institute of Government and Public Affairs, and Department of EconomicsUniversity of Illinois at ChicagoChicagoUSA
  5. 5.Department of Health Management & Policy and Department of EconomicsUniversity of IowaIowa CityUSA

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