Public Health Insurance Expansions and Non-Physician Providers: Evidence from Certified Nurse Midwives

Abstract

This study considers whether the Affordable Care Act (ACA) Medicaid Expansions resulted in changes in the use of non-physician providers. Medicaid Expansions may have impacted both payments to providers as well as insurance availability for patients. Using U.S. birth certificate records, we analyze whether the ACA Medicaid expansions influenced the trade-off between physicians and certified nurse-midwives (CNMs/CMs) for obstetric care. Our findings indicate that the ACA Medicaid expansions led to an increase in the utilization of CNMs/CMs and a decrease in physician-reported deliveries. This shift from physicians to CNMs/CMs is particularly noticeable in states with Medicaid reimbursement parity for CNMs/CMs. These results suggest that health insurance expansions may increase the use of non-physician providers, but only in cases where non-physician providers are reimbursed similarly to physicians.

Keywords: maternal health, Affordable Care Act, non-physician provider, Medicaid reimbursements, ACA Medicaid Expansions, certified nurse midwife

JEL Classification: I18, I11, I13, H51