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Effects of Medicaid Abortion Coverage on Mentally Unhealthy Days in Illinois
Saturday, November 15, 1:45 to 3:15pm, Property: Hyatt Regency Seattle, Floor: 5th Floor, Room: 511 - Quinault BallroomAbstract
It is critical to document the multiple, positive impacts of Medicaid coverage for abortion. The Hyde Amendment prohibits federal spending on abortion in Medicaid, imposing burdens on low-income people. States can provide Medicaid abortion coverage with state dollars only. Illinois introduced Medicaid abortion coverage in 2018. A recent study found that this policy change increased abortion utilization and reduced births. We examined mental health effects of the change, which could derive from preemptive access security and/or realized abortion access experiences and outcomes.
Using the 2014-2019 and 2021-2022 Behavioral Risk Factor Surveillance System, we created a sample of 347,844 self-reported females ages 18-44 in 48 comparison states. The outcome was reporting any days of poor mental health in the past month. We used difference-in-differences (DID) models, adjusting for sociodemographic covariates with state and year fixed effects and robust standard errors. The DID models were stratified at 400% federal poverty level (FPL).
In the pre-treatment period, 50% of Illinois residents reported mentally unhealthy days, compared to 47% in control states. Among those below 400% FPL, our DID model indicated a significant reduction in having any days of poor mental health among 18-44-year-old females in Illinois (6.4%-point, equivalent to 13% decline from baseline). We observed no significant changes for those above 400% FPL.
Our results suggest that Medicaid abortion coverage improved mental health among reproductive-aged women, especially those with lower incomes. Our findings add to a critical evidence base of the multiple benefits of Medicaid abortion coverage, suggesting further need for the repeal of the Hyde Amendment and the importance of state-covered abortion.