HLTH 3110 Week 8 Comparative Health Policy Paper Example

One Question Across a Border: How Coverage Continuity After Birth Differs Between U.S. Medicaid's Twelve-Month Option and Canada's Universal Provincial Plans

Student Name

Walden University

HLTH 3110: Current Issues in Healthcare Policy and Practice

Instructor Name

Month Day, Year

One Question Across a Border: How Coverage Continuity After Birth Differs Between U.S. Medicaid's Twelve-Month Option and Canada's Universal Provincial Plans

Bounding the Comparison

Comparisons between the United States and Canada often go badly because they try to compare everything at once: costs, outcomes, waiting times and politics. This paper compares one thing only. It asks whether a person who gives birth keeps health coverage without interruption through the first year after birth, and what determines whether they do, in two places: a U.S. state that has adopted the 12-month postpartum Medicaid option, and a Canadian province operating under the Canada Health Act. It does not compare the quality of care, maternal outcomes, costs or waiting times, because each of those depends on many factors beyond coverage continuity and would require evidence this paper does not have. Bounding the question is what makes the comparison fair.

The U.S. Side: Coverage Tied to a Category and a Clock

In the United States, Medicaid eligibility is categorical: a person qualifies because they belong to a group the program covers and meet its income rules. Pregnancy is one such category. Under the option created in 2021 and made permanent at the end of 2022, a state may keep pregnancy-based coverage in place for 12 months after the pregnancy ends. Continuity in the first year therefore depends on three things: whether the state adopted the option, whether the state's systems and staff apply it correctly and whether the person stays in contact with the program when notices are sent. After month 12, the person must qualify in another category, buy other coverage or go uninsured. Research before the extension showed that transitions around birth were a common source of gaps (Daw et al., 2017).

The Canadian Side: Coverage Tied to Residence

In Canada, publicly insured hospital and physician services are provided through provincial and territorial health insurance plans, which must meet the conditions of the federal Canada Health Act, including universality, meaning that all insured residents are covered on uniform terms (Government of Canada, n.d.). Eligibility depends on residence, not on pregnancy, income or employment. A resident who gives birth was covered before pregnancy, during it and after it, and coverage does not change because the pregnancy ended. Continuity in the first year depends mainly on remaining a resident of the province; a move to another province involves a waiting period under some provincial rules, during which the original province generally continues coverage.

This does not mean every service is covered. Prescription drugs outside hospitals, dental care and some other services are covered differently across provinces and often depend on private or targeted public plans (Martin et al., 2018). But for the hospital and physician care that dominates the immediate postpartum year, eligibility does not have a clock.

A Note on Choosing Canada

Canada was chosen for this comparison for three reasons. First, its health system is well documented in English-language sources, so its rules can be checked. Second, it shares a border, a similar income level and many health care practices with the United States, so differences in coverage design stand out rather than being lost among broader differences. Third, it represents a clear contrast in design: eligibility based on residence rather than on category. A comparison with a country whose system resembles ours more closely, such as one with multiple insurers and employer-based coverage, would answer a different question, about how insurance markets handle the postpartum period, and would be worth a separate paper.

The choice has a cost. Canada's provinces differ in which services they cover beyond hospital and physician care, and this paper speaks only to the core services that the federal act governs. A reader interested in postpartum mental health medications or dental care would need a province-by-province comparison.

What the Comparison Shows

Answered on the bounded question, the comparison is clear. In the U.S. state, continuity in the first year depends on a policy choice, its correct implementation and the person's ongoing contact with an eligibility system, and it ends at a fixed point. In the Canadian province, continuity for core services depends on residence and does not end because of the postpartum period. The 12-month option narrows the difference between the two systems for the first year, which is exactly what it was designed to do. It does not remove the underlying difference: one system ties coverage to a category and a clock, the other to where a person lives.

The comparison also explains why the U.S. extension needs the verification my position paper recommends. In a residence-based system, there is little administrative machinery that can end coverage early for a postpartum person. In a category-based system, the machinery that determines eligibility is also the machinery that can end it, so the policy's success depends on that machinery working.

What the Comparison Cannot Show

Because the comparison was bounded, it cannot support several claims that would be tempting. It cannot show that Canadian mothers have better outcomes because of continuous coverage; outcomes depend on many other differences between the countries. It cannot show that the U.S. should adopt a residence-based system; that question involves costs, taxes, politics and values far beyond this paper. And it cannot show that the 12-month option is insufficient; whether a year is enough depends on evidence about health needs after the first year, which my sources do not cover. A comparison bounded to one question earns a clear answer to that question and nothing more.

Why This Comparison Is Useful Anyway

A narrow comparison is useful because it isolates a design feature. U.S. policymakers debating whether to extend postpartum coverage further, or to simplify the transition at month 12, can see from Canada what coverage looks like when the clock is removed for core services, without having to accept or reject the entire Canadian system. That is also why the comparison is useful for an administrator in the U.S.: it highlights that much of the work of keeping postpartum patients covered in the United States is administrative work that a residence-based system does not need to do, and that this work deserves resources and attention. Our textbook makes a broader version of this point about how the structure of U.S. financing creates administrative burdens that other systems avoid (Shi & Singh, 2022).

References

Daw, J. R., Hatfield, L. A., Swartz, K., & Sommers, B. D. (2017). Women in the United States experience high rates of coverage 'churn' in months before and after childbirth. Health Affairs, 36(4), 598-606. https://doi.org/10.1377/hlthaff.2016.1241

Government of Canada. (n.d.). Canada Health Act. https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html

Martin, D., Miller, A. P., Quesnel-Vallée, A., Caron, N. R., Vissandjée, B., & Marchildon, G. P. (2018). Canada's universal health-care system: Achieving its potential. The Lancet, 391(10131), 1718-1735. https://doi.org/10.1016/S0140-6736(18)30181-8

Shi, L., & Singh, D. A. (2022). Delivering health care in America: A systems approach (8th ed.). Jones & Bartlett Learning.