In contrast to the preceding studies, Zhang et al. conducted a study between 2005 and 2007 to calculate the excessive rate of unfavorable outcomes in pregnancy within racial and ethnic groups. The study also aimed to measure the possibility of Medicaid savings that are linked to paid maternal care claims resulting from the inequalities that contribute to unfavorable maternal outcomes. A cross-sectional study using Medicaid Analytic eXtract (MAX) data was used to gather pregnancy outcome information from inpatient hospitals from 14 states (Florida, Alabama, Arkansas, North Carolina, Georgia, Louisiana, Kentucky, Mississippi, Maryland, Missouri, Tennessee, South Carolina, Virginia, and Texas). The study consisted of a little over 2 million patients who were insured with Medicaid and had a delivery code of maternal delivery stay. Zhang et al. found that, with the exception of gestational diabetes, African American women showed the worst outcomes out of all unfavorable pregnancy outcomes. These disparities are postulated as being multi-factorial, having causes stemming from complicated experiences with racism, poverty, and complex healthcare interactions. It was also found that women covered under Medicaid health insurance were more likely to have consistency in care from prenatal care through delivery compared to their counterparts. However, due to participation in Medicaid programs being influenced by reimbursement rates, some providers may choose to stop accepting Medicaid patients because of reimbursement delays and low payment rates, which could contribute to negative birth outcomes
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