Online Program

Assessing the Effectiveness of Safety Net Providers on Maternal and Infant Health Outcomes Since the Passage of the Affordable Care Act

Tuesday, November 3, 2015

Arlesia Mathis, Ph.D., CPH, CPM, Institute of Public Health, Florida A&M University, Tallahassee, FL

The passage of the Patient Protection and Affordable Care Act brings important changes to public health care delivery systems.  The purpose of this study is to examine changes in maternal and infant health outcomes in since the passage of the ACA in 2010. In addition, we will also examine increases and decreases in community health center services (CHCs).

Study Design

The study uses secondary data from the Health Resources and Services Administration (HRSA) and the 2013 National Profile of Local Health Departments (LHDs).  To simultaneously examine the geospatial patterns of service delivery, the researchers merged GIS shape files of LHD jurisdictions and location of CHCs with prenatal care services. The population indicators evaluated include low birth weight birth, infant mortality, and post neonatal mortality. The study also collected data from the U.S. Census, American Fact Finder, and County Health Rankings. The data analysis uses multivariate regression (Poisson and multinomial regression) and Geographic Information Systems (GIS).

Population Studied

The primary focus of this study is low-income, underserved women and safety-net providers.

Principle Findings

We expect large variation in the distribution of local health department resources and community health center services. We also expected reductions in disparities in areas that adopted health care reform changes compared to areas that did not.


The passage of the Affordable Care Act presented opportunities and challenges to improve disparities in maternal and infant services. Significant investments in provider capacity promised much needed expansion of services.  However, for safety net providers in areas that did not expand Medicaid coverage, changes brought about by the ACA may threaten the providers’ ability to offer much needed services.

Implications for Policy or Practice

Areas of increasing disparity indicate urgent policy attention and practice intervention given that more individuals and families obtain services from safety net providers.

Learning Areas:

Provision of health care to the public
Public health or related public policy

Learning Objectives:
Identify increases or decreases in infant mortality in conjunction with increases and decreases in maternal and infant health services since the passage of the Affordable Care Act.

Keyword(s): Health Care Reform, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a Ph.D. in Public Health specializing in Health Policies and Programs. In addition, I have been the principal investigator on several grants (NIH, RWJF, etc.) examining the delivery of health services in underserved populations. Finally, I am the first author on multiple peer-reviewed publications examining maternal and infant health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.