When women of childbearing age gain health insurance, comparing birth outcomes that occur before and after policy changes may confound two separate impacts of coverage. Health insurance could affect who gives birth and also directly improve maternal and child health. We address this question using the Affordable Care Act young adult provision, comparing birth outcomes of 24–25 years to outcomes among older young adults. We show that the composition of mothers shifted toward less advantaged groups. Accounting for this shift, we find direct improvements in prenatal care and pregnancy-related health but no statistically significant improvements in infant health.

中文翻译：

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健康保险对出生相关结果的异质性影响：分解成分变化与直接变化

当育龄妇女获得健康保险时，比较政策变更前后发生的生育结局可能会混淆承保范围的两个不同影响。健康保险可以影响谁生育，也可以直接改善母婴健康。我们使用《平价医疗法案》中的年轻人条款来解决这个问题，将 24-25 岁的出生结果与年长的年轻人的结果进行比较。我们表明，母亲的构成转向了弱势群体。考虑到这一转变，我们发现在产前保健和与妊娠相关的健康方面有直接的改善，但在婴儿健康方面没有统计学上的显着改善。