Effects of the Affordable Care Act Medicaid Expansions on Labor Force Participation Among Women in the Period Surrounding Childbirth

Background and Purpose: Changes in work status often accompany the period surrounding childbirth, as women change jobs, work hours, and take family or sick leave after childbirth. Increased access to health insurance coverage through expansions in Medicaid under the Affordable Care Act (ACA) could increase women’s labor force participation through improving health and women’s ability to work before, during, and after childbirth, thereby increasing work hours and earnings. This study examines the effects of the Medicaid expansions under the ACA on labor force outcomes among women who gave birth in the past year, including pre-birth and post-birth periods, and stratified by maternal age and race/ethnicity.

Methods: This study uses 2008-2019 American Community Survey data and difference-in-difference models to assess Medicaid expansion effects on labor force participation among women reporting a birth in the past year. The sample is limited to women aged 19 years or older who gave birth in the past year. To isolate women most likely to benefit from Medicaid expansion, we further limit the sample to women with educational attainment of a high school degree or less, for a total sample size of 156,364 women with a birth in the past year. Outcomes include: having worked at any point during the last year, usual number of hours worked per week in the past year among those who worked, working 50-52 weeks in the last year among those who worked, income from wages and salary in the last year, working last week, and absence from work last week. Models include year and state fixed-effects and covariates for age, marital status, race/ethnicity, number of the respondent’s children in the household, and the state-year unemployment rate for women.

Results: Medicaid expansion was associated with an increase in working in the last year by 1.8 percentage points (95% CI: 0.4 to 3.2, p=0.014), from a pre-policy baseline average of working among 53.2 percent of women with a birth in the past year. These increases are concentrated among Asian women, women age 19-29, and women age 40 years and older. We find differential effects on postpartum work by maternal age and race/ethnicity, with decreases in postpartum work among Black women, increases in postpartum absences among women age 30-39, and increases in postpartum work among women age 40 years and older.

Conclusions and Implications: This study is the first to focus on the impacts of ACA Medicaid expansions on the labor force participation of women with recent birth. This is significant as these women’s health and labor force trajectories may be uniquely affected by improved insurance access. The effects of Medicaid expansions varied before and after the birth, allowing more women to work during the year of childbirth overall, but with inconsistent effects during the postpartum period. These findings reveal that maternal health and insurance access intersect with women’s ability and need to work during and after pregnancy.