Medicaid and Prenatal Care

The findings reported by Piper and colleagues1that appear in this issue ofThe Journalshould not be baffling or discouraging to policymakers concerned with reducing the nation's infant mortality rate. The authors evaluate the effects in Tennessee of the first of a series of expansions in Medicaid eligibility that were intended to improve the outcome of pregnancy among women with low incomes. This report, and others that will surely follow, should help shape future maternal and child health financing policies. Since the early 1980s, Congress has repeatedly amended Medicaid (Omnibus Budget Reconciliation Act, 1981, 1986, 1987, and 1989; Deficit Reduction Act, 1984; Consolidated Omnibus Budget Reconciliation Act, 1985; and Catastrophic Care, 1988) to expand incremental eligibility for pregnant women and infants.2Congress initially conceptualized infant mortality as a problem of access to health care. Congressional action was influenced by the findings of the Institute of Medicine's Committee