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Background: Despite including several provisions focused on American Indian and Alaska Native (AI/AN) people, few studies look at the Affordable Care Act (ACA)'s potential impact among AI/AN birth givers, a group that experiences a disproportionate burden of adverse pregnancy outcomes. While ACA repeal conversations are ongoing, our objective was to examine changes, and equity in changes, in health care interactions before and after the ACA between AI/AN birth givers and white birth givers. Materials and Methods: We used the 2009?2015 data from the Pregnancy Risk Assessment Monitoring System, a state-level representative sample of individuals with live births. We included those identifying as AI/AN people or white people to estimate change over time in five health measures. We used adjusted linear probability regression models to compare prepregnancy recall periods before, during, and after the implementation of the ACA with the period just before implementation. Results: Among AI/AN birth givers, prepregnancy Medicaid coverage, multivitamin/prenatal use, and teeth cleaning increased by 10 percentage points (ppts), 5 ppts, and 9 ppts, respectively, and were larger than increases experienced by white birth givers (5, 3, and 2?4 ppts, respectively). Increases in preventive health care screening (12?18 ppts) and provider conversation (8?10 ppts) were similar for AI/AN birth givers and white birth givers. Discussion: While some ACA-associated increases in health care coverage and care were quantitatively larger among AI/AN birth givers compared with white birth givers, the existence of pre-ACA disparities suggests that the ACA may have reduced, but may not have eliminated, health inequities between AI/AN birth givers and white birth givers.

Poor perinatal mental health is a common pregnancy-related morbidity with potentially serious impacts that extend beyond the individual to their family. A possible contributing factor to poor perinatal mental health is discontinuity in health insurance coverage, which is particularly important among low-income people. We examined impacts of Medicaid expansion on prepregnancy depression screening and self-reported depression and postpartum depressive symptoms and well-being among low-income people giving birth. Medicaid expansion was associated with a 16 percent decline in self-reported prepregnancy depression but was not associated with postpartum depressive symptoms or well-being. Associations between Medicaid expansion and prepregnancy mental health measures increased with time since expansion. Expanding health insurance coverage to low-income people before pregnancy may improve perinatal mental health.