WASHINGTON (AP) – Labor and delivery are considered the most risky times for new mothers, but many women die in the weeks and months after delivery. Now, a provision in the COVID-19 relief bill could help change that.
The legislation gives states the option of extending Medicaid coverage for women on low to modest incomes for an entire year after childbirth. Currently, states are required to provide 60 days of coverage, but medical experts point to research showing that women can die of pregnancy-related illnesses up to a year after childbirth and that 3 in 5 of all these deaths are preventable.
Maternal health provisions would make it easier for states to cover new mothers for an entire year, reducing the time and paperwork required to obtain Washington’s approval under Medicaid, as well as the Child Health Insurance Program. Maternal health advisory groups in 19 states, from Texas to Massachusetts, and from Washington to Tennessee, recommended such an extension. Last year, a bipartisan bill to do this was passed in the House, but was not passed in the Senate.
The legislation was led by Congressman Robin Kelly, D-Ill., Who serves on the House committee that oversees Medicaid, the federal state program that covers about 1 in 5 Americans, from many newborns to low-income adults and fragile nurses residing at home. Kelly explained that a constituent called his attention to the problem several years ago.
“I never realized that maternal mortality was such a problem in this country,” said Kelly, who represents Chicago.
It is particularly serious for black women, whose pregnancy-related mortality rate is three times that of white women. “For black women, it cuts across socioeconomic levels,” said Kelly, who is black. “It is a matter of health equity.”
A parliamentary commission known as MACPAC, which advises lawmakers on Medicaid policy, is recommending that Congress go beyond what is in the legislation. The commission recently voted to urge lawmakers to make a full year of coverage the standard in all states and for the federal government to pay the full cost.
Medicaid may play a key role because the program already pays about 4 out of 10 births, said Hannah Katch, of the Center for Budget and Policy Priorities.
But American women are now much more likely to die from complications related to pregnancy and childbirth than women in 10 other economically advanced countries, according to a recent study by the Commonwealth Fund. Compared countries included Canada, Germany, Australia and the United Kingdom. The lack of postpartum care in the United States was seen as part of the problem.
About 700 American women die annually from pregnancy-related problems, and just over half of those deaths occur some time after the woman gave birth, according to data from the Centers for Disease Control and Prevention. Almost 12% of maternal deaths occur 43 to 365 days after delivery. Surprisingly, heart disease is responsible for more than a third of deaths.
“There are many problems that do not necessarily appear immediately, whether during pregnancy or childbirth,” said Dr. Veronica Pimentel, an obstetrician from Hartford, Connecticut, who specializes in caring for high-risk patients. “It has to do with underlying conditions that women may have, including obesity and old age.” A full year of Medicaid coverage would promote continuity of care, allowing new mothers to continue to consult with the doctors who guided them during pregnancy, she added.
Medical groups hope to see a strong response from the states.
“This new path is much less costly for states,” said Emily Eckert, a health policy expert at the American College of Obstetricians and Gynecologists. “Some of the obstacles we hear about advocates on the ground are going to be removed one way.”
The extension of the COVID-19 bill will be available from next year. But then it would expire after five years, unless Congress re-approved it or made it permanent.
Some Republicans who disdain the $ 1.9 trillion coronavirus relief package say they would like to see maternal health provisions made permanent.
“We must strive to improve maternal health outcomes and reduce maternal mortality,” said Rep. Michael Burgess, R-Texas, who co-sponsored the legislation with Kelly, the Chicago Democrat, at the last Congress. “If you’re going to spend all that money, spend it on the right policies.”
Kelly says he has no problem with that. “Many of these deaths are preventable, so we need to do all the things that we can do,” she said.