cc: @jamiedaw.bsky.social, @alison-galbraith.bsky.social, @healthpolicydpm.bsky.social

Thank you to my amazing coauthors - Jamie Daw, Alison Galbraith, Sarah Gordon, Anjali Kaimal, and Laura Garabedian! And biggest thank you to the PRAMS working group – PRAMS is the only data with which we could have evaluated this policy and is an essential source to study maternal + infant health.

New York passed their BHP in 2016 – but Oregon passed a BHP in 2024, and Washington DC’s BHP was approved this past summer (!), with plans to start in January 2026. BHPs are an active policy option for states to potentially protect their residents who may lose coverage from the end of the EPTCs.

This is especially salient as the expected expiration of the EPTCs nears. BHPs could be a state-level policy option leveraged to mitigate the projected coverage losses of lower-income enrollees, including those who become pregnant.

While we find no impact on preconception uninsurance, we find that individuals substituted to the BHP largely from private coverage which may represent meaningful cost savings for individuals in the perinatal period -- BHPs are much less expensive ($0 premiums) than silver Marketplace plans or ESI.

We find that NY’s BHP increased New York State of Health (BHP+Marketplace) coverage among childbearing individuals prior to pregnancy, and that this coverage was sustained through to the postpartum period.

The BHP is a provision of the ACA that allows states to create an insurance coverage option for lower-income residents (138-200% FPL). BHP coverage is akin to Medicaid in cost sharing + benefit design, but is sought from the state Marketplace, and effectively functions as a bridge btwn the two.

👋👋