# Reproductive care in the safety net: Women's health after Affordable Care Act implementation (EVERYWOMAN)

> **NIH AHRQ R01** · OCHIN, INC. · 2021 · $362,660

## Abstract

PROJECT SUMMARY
Evidence-based reproductive care decreases morbidity and mortality for women and their children, reduces
disparities, and saves money; however, many women do not receive needed reproductive care. Cost and lack
of health insurance are known barriers to receiving care, and women who are poor and representative of racial
and/or ethnic minorities are least likely to receive needed reproductive care. The Affordable Care Act (ACA)
prioritized reproductive health care as an essential component of women's clinical preventive services and
called for every state to significantly expand Medicaid coverage by 2014. Little is yet known about how ACA
Medicaid expansions are impacting the delivery of reproductive health care. The 2012 United States (US)
Supreme Court ruling that made ACA Medicaid expansions optional for states created a natural experiment to
answer this important question. As of January, 2016, 31 states and the District of Columbia had expanded
Medicaid, while 19 states had not. We will use this unprecedented natural experiment to study the impact of
the ACA and Medicaid expansion on the provision of women's reproductive health care in community health
centers (CHCs). The proposed Reproductive care in the safety net: Women's health after Affordable Care Act
implementation (EVERYWOMAN) project is a mixed-methods study that will leverage patient-level electronic
health record (EHR) data from two CHC networks: the Community Health Applied Research Network (CHARN)
and the ADVANCE clinical data research network (CDRN). Together, the CHARN and ADVANCE research
data warehouses have patient-level data on over 3 million patients from CHCs across 26 states (14 expansion
and 12 non-expansion states). These data will be augmented through qualitative data on patient and provider
perceptions of the impact of the ACA on reproductive health care in low-income and vulnerable populations.
The specific aims are as follows:
 Aim 1: Describe provision of women's reproductive health care before and after implementation of the
 ACA and between expansion and non-expansion states.
 Aim 2: Identify individual, clinic, and state-level factors associated with provision of women's
 reproductive health care.
 Aim 3: Understand provider and patient perceptions of the provision and utilization of reproductive
 health care in low-income and vulnerable populations.
This project builds on our team's experience in insurance, primary care, women's health, and utilizing EHR
clinical data for research. The ADVANCE and CHARN datasets position us uniquely to study national-level
impacts of the ACA. Findings will be relevant to policy and practice, informing efforts to enhance the provision
of timely, evidence-based reproductive care, improve health outcomes, and reduce disparities among low-
income vulnerable populations of women.

## Key facts

- **NIH application ID:** 10148802
- **Project number:** 5R01HS025155-05
- **Recipient organization:** OCHIN, INC.
- **Principal Investigator:** Erika K. Barth Cottrell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $362,660
- **Award type:** 5
- **Project period:** 2017-08-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10148802

## Citation

> US National Institutes of Health, RePORTER application 10148802, Reproductive care in the safety net: Women's health after Affordable Care Act implementation (EVERYWOMAN) (5R01HS025155-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10148802. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*