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Population Research and Policy Review

, Volume 37, Issue 5, pp 729–749 | Cite as

Business Cycles, Medicaid Generosity, and Birth Outcomes

  • Sarah Hamersma
  • Yilin Hou
  • Yusun Kim
  • Douglas Wolf
Original Research

Abstract

Birth outcomes influence many aspects of later life health and wellbeing, making healthcare access during pregnancy a policy priority. Low-income mothers often depend on Medicaid, for which eligibility is determined by their income relative to state eligibility thresholds. The prevalence of adverse birth outcomes is known to exhibit cyclical variation, due in part to changes in the composition of women giving birth in response to changing economic conditions. However, cyclical variation in adverse birth outcomes also varies with respect to Medicaid eligibility thresholds. Our analysis uses birth-records data for 2000 through 2013, aggregated into 173,936 county-by-quarter observations and linked to county-level unemployment rates and state-level parental Medicaid thresholds. Using fixed-effects negative binomial models, we examine the role of Medicaid generosity in influencing birth outcomes across business cycles. We test for interactions between Medicaid and unemployment, hypothesizing that the negative effects of recessions are worse where Medicaid thresholds are more restrictive. We find that higher Medicaid generosity dampens the negative effects of recessions on birth outcomes. The extent to which Medicaid interacts with unemployment also varies according to the age and race composition of mothers; in particular, Black mothers are both most affected by unemployment and most responsive to Medicaid generosity. Given current concerns about racial gaps in both infant and maternal mortality, our findings suggest that Medicaid may be an important feature of a strategy to close gaps in the prevalence of adverse birth outcomes across racial groups, especially during bust years.

Keywords

Medicaid Unemployment Birth outcomes Business cycles Race differences 

References

  1. Abu-Saad, K., & Fraser, D. (2010). Maternal nutrition and birth outcomes. Epidemiological Reviews, 32, 5–25.CrossRefGoogle Scholar
  2. Allison, P. D., & Waterman, R. P. (2002). Fixed-effects negative binomial regression models. Sociological Methodology, 32(1), 247–265.CrossRefGoogle Scholar
  3. Black, S. E., Devereux, P. J., & Salvanes, K. G. (2007). From the cradle to the labor market? The effect of birth weight on adult outcomes. Quarterly Journal of Economics, 122, 409–439.CrossRefGoogle Scholar
  4. Boudreaux, M. H., Golberstein, E., & McAlpine, D. D. (2016). The long-term impacts of Medicaid exposure in early childhood: Evidence from the program’s origin. Journal of Health Economics, 45, 161–175.CrossRefGoogle Scholar
  5. Buckles, K. S., & Hungerman, D. M. (2013). Season of birth and later outcomes: Old questions, new answers. Review of Economics and Statistics, 95(3), 711–724.CrossRefGoogle Scholar
  6. Butz, W. P., & Ward, M. P. (1979). The emergence of countercyclical US fertility. American Economic Review, 69(3), 318–328.Google Scholar
  7. Cameron, A. C., & Trivedi, P. K. (1998). Regression analysis of count data. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  8. Cherlin, A., Cumberworth, E., Morgan, S. P., & Wimer, C. (2013). The effects of the Great Recession on family structure and fertility. Annals of the American Academy of Political and Social Sciences, 650, 214–231.CrossRefGoogle Scholar
  9. Cnattingius, S., Forman, M. R., Berendes, H. W., & Isotalo, L. (1992). Delayed childbearing and risk of adverse perinatal outcome: A population-based study. Journal of the American Medical Association, 268, 886–890.CrossRefGoogle Scholar
  10. Comolli, C. L. (2017). The fertility response to the Great Recession in Europe and the United States: Structural economic conditions and perceived economic uncertainty. Demographic Research, 36, 1549–1600.CrossRefGoogle Scholar
  11. Currie, J., & Gruber, J. (1996). Saving babies: The efficacy and cost of recent changes in the Medicaid eligibility of pregnant women. Journal of Political Economy, 104, 1263–1296.CrossRefGoogle Scholar
  12. Currie, J., & Schwandt, H. (2014). Short- and long-term effects of unemployment on fertility. Proceedings of the National Academy of Science, 111(41), 14734–14739.CrossRefGoogle Scholar
  13. Dehejia, R. H., & Lleras-Muney, A. (2004). Booms, busts, and babies’ health. Quarterly Journal of Economics, 119(3), 1091–1130.CrossRefGoogle Scholar
  14. Delbaere, I., Verstraelen, H., Goetgeluk, S., Martens, G., De Backer, G., et al. (2007). Pregnancy outcome in primiparae of advanced maternal age. European Journal of Obstetrics and Gynecology and Reproductive Biology, 135, 41–46.CrossRefGoogle Scholar
  15. DeLeire, T., Lopoo, L. M., & Simon, K. (2011). Medicaid expansions and fertility in the United States. Demography, 48(2), 725–747.CrossRefGoogle Scholar
  16. Ellison, P. T., Valeggia, C. R., & Sherry, D. S. (2005). Human birth seasonality. In D. K. Brockman & C. P. van Schaik (Eds.), Seasonality in primates: Studies of living and extinct human and non-human primates (pp. 379–399). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  17. Galbraith, V. L., & Thomas, D. S. (1941). Birth rates and the interwar business cycles. Journal of the American Statistical Association, 36(216), 465–476.CrossRefGoogle Scholar
  18. Goldstein, R. F., Abell, S. K., Ranasinha, S., Misso, M., Boyle, J. A., et al. (2017). Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. Journal of the American Medical Association, 317, 2207–2225.CrossRefGoogle Scholar
  19. Groves, L. H., Hamersma, S., & Lopoo, L. M. (2018). Pregnancy Medicaid expansions and fertility: Differentiating between the intensive and extensive margins. Population Research and Policy Review, 37(3), 461–484.CrossRefGoogle Scholar
  20. Hamersma, S. (2013). The effects of Medicaid earnings limits on earnings growth among poor workers. The B.E. Journal of Economic Analysis and Policy, 13(2), 887–919.CrossRefGoogle Scholar
  21. Hamersma, S., & Kim, M. (2013). Participation and crowd out: Assessing the effects of parental Medicaid expansions. Journal of Health Economics, 32(1), 160–171.CrossRefGoogle Scholar
  22. Ingram, D. D., Parker, J. D., Schenker, N., Weed, J. A., Hamilton, B., Arias, E., et al. (2003). United States Census 2000 population with bridged race categories. Vital and Health Statistics Series 2—Data Evaluation and Methods Research, 2(135), 1–55.Google Scholar
  23. James, W. H. (1990). Seasonal variation in human births. Journal of Biosocial Science, 22(1), 113–119.CrossRefGoogle Scholar
  24. Joyce, T., Kaestner, R., & Kwan, F. (1998). Is Medicaid pronatalist? The effect of eligibility expansions on abortions and births. Family Planning Perspectives, 30, 108–127.CrossRefGoogle Scholar
  25. Kirz, D. S., Dorchester, W., & Freeman, R. K. (1985). Advanced maternal age: The mature gravida. American Journal of Obstetrics and Gynecology, 152(1), 7–12.CrossRefGoogle Scholar
  26. Lam, D. A., & Miron, J. A. (1996). The effects of temperature on human fertility. Demography, 33(3), 291–305.CrossRefGoogle Scholar
  27. Lindo, J. M. (2015). Aggregation and the estimated effects of economic conditions on health. Journal of Health Economics, 40, 83–96.CrossRefGoogle Scholar
  28. Macunovich, D. J. (1995). The Butz-Ward fertility model in the light of more recent data. Journal of Human Resources, 30(2), 229–255.CrossRefGoogle Scholar
  29. Margerison-Zilko, C. E., Li, Y., & Luo, Z. (2017). Economic conditions during pregnancy and adverse birth outcomes among singleton live births in the United States, 1990-2013. American Journal of Epidemiology, 186(10), 1131–1139.CrossRefGoogle Scholar
  30. Menclova, A. K. (2013). The effects of unemployment on prenatal care use and infant health. Journal of Family and Economic Issues, 34(4), 400–420.CrossRefGoogle Scholar
  31. Miller, S. & Wherry, L. (2018). The long-term effects of early life Medicaid coverage. Journal of Human Resources, forthcoming (published online January 30, 2018).Google Scholar
  32. Molina, G., Weiser, T. G., Lipsitz, S. R., Esquivel, M. M., Uribe-Leitz, T., Azad, T., et al. (2015). Relationship between Cesarean delivery rate and maternal and neonatal mortality. Journal of the American Medical Association, 314(21), 2263–2270.CrossRefGoogle Scholar
  33. Moster, D., Lie, R. T., & Markestad, T. (2008). Long-term medical and social consequences of preterm birth. New England Journal of Medicine, 359(3), 262–273.CrossRefGoogle Scholar
  34. Ogburn, W. F., & Thomas, D. S. (1922). The influence of the business cycle on certain social conditions. Journal of the American Statistical Association, 18(139), 324–340.CrossRefGoogle Scholar
  35. Orsal, D. D., & Goldstein, J. R. (2010). The increasing importance of economic conditions on fertility. Working paper for the Annual Meetings of the Population Association of America. Retrieved June 9, 2017, from http://www.demogr.mpg.de/papers/working/wp-2010-014.pdf.
  36. Roseboom, T., de Rooij, S., & Painter, R. (2006). The Dutch famine and its long-term consequences for adult health. Early Human Development, 82(8), 485–491.CrossRefGoogle Scholar
  37. Rudowitz, R., Snyder, L., & Smith, V. K. (2015). Medicaid enrollment and spending growth: FY 2015 and 2016. October 2015 Issue Brief. Menlo Park: The Kaiser Commission on Medicaid and the Uninsured.Google Scholar
  38. Ruhm, C. J. (2000). Are recessions good for your health? Quarterly Journal of Economics, 115(2), 617–650.CrossRefGoogle Scholar
  39. Ruhm, C. J. (2003). Good times make you sick. Journal of Health Economics, 22(4), 637–658.CrossRefGoogle Scholar
  40. Ruhm, C. J. (2005). Healthy living in hard times. Journal of Health Economics, 24(2), 341–363.CrossRefGoogle Scholar
  41. Sameem, S., & Sylwester, K. (2017). The business cycle and mortality: Urban versus rural counties. Social Science and Medicine, 175, 28–35.CrossRefGoogle Scholar
  42. Schneider, D. (2015). The great recession, fertility, and uncertainty: Evidence from the United States. Journal of Marriage and Family, 77(5), 1144–1156.CrossRefGoogle Scholar
  43. Seiver, D. A. (1985). Trend and variation in the seasonality of U.S. fertility, 1947-1976. Demography, 22(1), 89–100.CrossRefGoogle Scholar
  44. Silver, M. (1965). Births, marriages, and economic cycles in the United States. Journal of Political Economy, 73(3), 237–255.CrossRefGoogle Scholar
  45. Snowden, J. M., Tilden, E. L., Snyder, J., Quigley, B., Caughey, A. B., & Cheng, Y. M. (2015). Planned out-of-hospital birth and birth outcomes. New England Journal of Medicine, 373(27), 2642–2653.CrossRefGoogle Scholar
  46. Stetsenko, S. (2010). Essays on the macroeconomics of labor markets. Dissertation, University of Pennsylvania. Retrieved June 9, 2018, from https://repository.upenn.edu/edissertations/138.
  47. Strand, L. B., Barnett, A. G., & Tong, S. (2011). The influence of season and ambient temperature on birth outcomes: A review of the epidemiological literature. Environmental Research, 111(3), 451–462.CrossRefGoogle Scholar
  48. Tyrell, J., Richmond, R. C., Palmer, T. M., Feenstra, B., Rangarajan, J., Metrustry, S., et al. (2015). Genetic evidence for causal relationships between maternal obesity-related traits and birth weight. Journal of the American Medical Association, 315(11), 1129–1140.CrossRefGoogle Scholar
  49. Zavodny, M., & Bitler, M. P. (2010). The effect of Medicaid eligibility expansions on fertility. Social Science and Medicine, 71(5), 918–924.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Public Administration and International Affairs, Maxwell School of Citizenship and Public AffairsSyracuse UniversitySyracuseUSA

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