Implications of “One Big Beautiful Bill” for Maternal Health in the U.S.

Session Submission Type: Late-Breaking Roundtable

Abstract

The United States has significantly higher rates of maternal morbidity and mortality than other high-income countries, which is driven, in part, by inadequate access to health insurance and health care. Health insurance coverage before, during and after pregnancy is associated with increased access to care and improved maternal health outcomes. Over the last 15 years, the Affordable Care Act (ACA) alongside state-level Medicaid policies have notably improved health insurance coverage and care during and after pregnancy. However, the July 2025 Federal Budget Reconciliation Law (i.e., “One Big Beautiful Bill” [OBBB]) includes numerous provisions that threaten health insurance coverage and care for pregnant people, particularly for low- and moderate-income pregnant people who rely on Medicaid and ACA Marketplaces. For instance, OBBB includes provisions that increase the administrative burden of enrolling in Medicaid and Marketplace plans, shorten enrollment windows and retroactive coverage, limit eligibility for immigrants, and restrict reimbursement for reproductive health services. As states react to cuts to federal Medicaid spending, there will be further reductions to Medicaid eligibility, covered benefits, and provider payment rates, which will have immediate impacts on pregnant and postpartum patients and the health care ecosystems that serve them. The panelists for the late-breaking roundtable will discuss how provisions of the OBBB are expected to impact health insurance coverage and health care for pregnant and postpartum people in the U.S. The panelists will discuss the implications of the OBBB for pregnant people within the context of Medicaid, ACA Marketplaces, and immigrant health, and how recent threats to national health databases limit our ability to monitor the impact of these policy changes. Panelists will highlight relevant evidence from recent and ongoing research on health insurance coverage and care for pregnant people and discuss potential state-level policy responses that could help mitigate the negative impact of the OBBB on maternal health. The roundtable will actively engage the audience by offering a Q&A period after each talk and eliciting audience input on research priorities and potential state-level policy responses.

Policy Area

• Health Policy

Secondary Policy Area

• Family and Child Policy

Organizer

• Margaret McConnell, Harvard University

Speakers

• Megan Cole Brahim, Harvard University

• Laura Garabedian, Harvard University