Last week, lawmakers voted to advance legislation that would give states the option to extend the public insurance option for new mothers to a year.
Lana Donath is a 29-year-old woman who lives in Texas. She didn’t have health insurance when she found out she was pregnant last year, but applied and was approved for Medicaid quickly. She gave birth to her first child in February. “I received the best care I could’ve possibly asked for in regards to being pregnant and delivering my child,” Donath told COURIER. “However, losing Medicaid not long after I gave birth was definitely a challenge.”
Donath said she has minor health issues right now—including migraines that are affecting her vision and pain from a recent fall— but can’t afford to go to a doctor. Just worrying about what could happen while she doesn’t have insurance is also stressful, she added.
Uninsured women who become pregnant can obtain comprehensive health services through Medicaid if their family income is below certain levels. Although states have different eligibility requirements, Medicaid coverage currently covers the span of the pregnancy and up to two months after the birth of the baby.
“Motherhood is so hectic and having Medicaid for a year instead of 60 days would have given me a peace of mind that I didn’t even know I needed,” Donath said. “I am lucky enough to be able-bodied. I can’t imagine the struggle that anyone with a disability or illness has to endure.”
“Motherhood is so hectic and having Medicaid for a year instead of 60 days would have given me a peace of mind that I didn’t even know I needed.”
Last week, a U.S. House subcommittee voted to advance legislation that would help more women like Donath who experience gaps in health care coverage postpartum. Introduced by Illinois Reps. Robin Kelly, Lauren Underwood and others, the Helping Medicaid Offer Maternity Services (MOMS) Act of 2019 would give states the option to extend Medicaid coverage for new mothers to a year.
According to the bill’s text, the legislation would increase federal medical assistance funding for states that do by 5 percent.
“Incentivizing postpartum Medicaid expansion is a critical first step in preventing maternal deaths by ensuring new moms can see their doctor,” Rep. Kelly said in a statement. “This is a good, bipartisan first step, but it must be the first of many.”
The bill has support from both sides of the aisle. During this week’s Subcommittee on Health hearing, Republican Rep. Buddy Carter from Georgia testified that experts have “resoundingly” shown that 60 days of postpartum care, the current standard for Medicaid in most states, “is simply not enough.”
Last year, the American College of Obstetricians and Gynecologists released revised guidelines for healthcare providers regarding the period of time after a person gives birth. Postpartum care, they wrote, “should become an ongoing process, rather than a single encounter.” Most women see a provider for a single postpartum follow-up visit six weeks after having their child—and that’s it. Optimizing this care, they added, “will require policy changes.”
Carter, who represents the state ranked the worst in the country for maternal mortality, stated: “There’s no silver bullet to our maternal mortality [crisis] but I do believe this is one of the single most important policy changes we can make to improve health outcomes for moms across the country.”
Approximately 700 women die each year in the United States because of pregnancy or delivery complications, and Black women are disproportionately represented in that figure. According to the Centers for Disease Control and Prevention, 36 percent of maternal deaths happen during delivery or the week after, and 33 percent occur between one week and up to a year after a person gives birth. Most are preventable.
Another less talked about statistic has to do with maternal morbidity, or any physical or mental illness or disability directly related to pregnancy and/or childbirth. Examples of such complications include organ failure, cardiac arrest, sepsis, hysterectomy and others. According to the CDC, the rate of severe maternal morbidity has increased in recent years: In 2014, more than 50,000 American women experienced a dangerous or life-threatening complication related to their experience of becoming a mother.
Monifa Bandele is the senior vice president of MomsRising, an advocacy organization tackling various issues facing women, mothers, and families. “Right now,” she told COURIER, “Medicaid is the payor for nearly half of births in this country but too many moms lose their Medicaid coverage just 60 days after giving birth, even though most will have at least one health complication within a year of doing so. By extending Medicaid coverage to moms for a year, the bill will support healthier mothers and families. Its enactment would send a strong message that our country is serious about improving maternal health.”
But, she added, “we would like to see the bill go farther by requiring states to provide this coverage and the federal government to make a significant financial investment to ensure the coverage is meaningful.”
One likely obstacle to getting the Helping MOMS Act passed, of course, will be funding. During last Wednesday’s hearing, Republican Rep. Larry Buschon of Illinois noted that, although he supported the legislation “conceptually,” he thought they would “have to be realistic and find some funding offsets.”
In response, Florida Rep. Kathy Castor pointed to data from the 2019 March of Dimes Report Card, which offers analysis on the preterm birth rate in the US. “Of course,” she said, “the offsets are important to pay for things. But when we’re talking about pregnant women and children, they say for every baby that’s born prematurely, it costs the state around $65,000.”
“It would probably cost us less to actually do something to prevent these things from happening in the first place.”