By ROSEMARIE DAY and DEBORAH GORDON
Mothers deserve more than a day of recognition this year—they deserve the whole month, and more. The pandemic has been particularly hard on women, especially poor women and women of color.
To demonstrate the appreciation mothers deserve this Mother’s Day, we should get them something they really need: health care. To improve maternal health, we should look to the Medicaid program, long a pathway to accessible, quality health care for low-income Americans. Medicaid is especially important for mothers; it covers close to half of all births in the U.S.
Now, states have the opportunity to do even more for moms.
The American Rescue Plan signed into law in March gives every state the option to extend Medicaid maternity coverage for up to 12 months postpartum, a significant increase from the current limit of just 60 days. Illinois has already announced it will extend postpartum coverage; other states should follow. Extending the guaranteed coverage period will increase access to postnatal care during this ‘fourth trimester’ to ensure that women can access treatment for common conditions like postpartum depression as well as preventing organ prolapse or hemorrhage. Not only mothers will benefit. Parental insurance is associated with better health for children, including a lower risk of adverse childhood experiences.
In addition, the American Rescue Plan offers an opening to expand Medicaid with even more federal funding than is currently available through the Affordable Care Act. The 12 states, mostly in the South, that have not expanded their Medicaid programs are leaving hundreds of thousands of women without the support they deserve.
Expanding Medicaid programs will provide robust access to health care to more women and reduce maternal morbidity and mortality, which has reached crisis proportions among many women of color. Black and Indigenous women are more likely than other women to die during pregnancy, childbirth, and the postpartum period. According to the CDC, the maternal mortality rate is 2.5 times higher for Black women than white women. Disparate access and uneven quality of care, higher rates of chronic illness, and racism all play a part in that grim statistic.
The disproportionate burden of maternal mortality and adverse outcomes from childbirth has long-lasting effects on mothers and their children. Black newborns have an increased risk for long-term complications resulting from pre-birth complications. They may also face generational poverty and trauma in the long run if they are born to a mother who dies during childbirth.
Racial disparities in maternal health are getting much-needed attention. Celebrities from Serena Williams to Beyonce have spoken out about their own experiences with maternity complications. The Black Maternal Health Momnibus Act was reintroduced in Congress this past February. The bill would fund community-based services, mental health care, research, and data collection to better understand and improve Black maternal health outcomes. And a major health insurer recently announced its commitment to reducing Black maternal mortality by 50% in five years.
One of the most important ways to reduce Black maternal mortality is by expanding Medicaid. Expanding the Medicaid program works. Fewer moms die. A 2020 study found that maternal mortality rates were lower by 6.65 maternal deaths per 100,000 live births in states that had expanded Medicaid. This effect was concentrated among non-Hispanic Black women, which suggests that Medicaid expansion alleviates some of the disparities in health outcomes for Black women.
Maternal mortality rates were even lower in Medicaid expansion states (by 7.01 maternal deaths per 100,000 live births) later in the postpartum period (more than 42 days after birth). Longer-term postnatal care may have a substantial impact on reducing maternal mortality. And because the majority of the states that haven’t expanded Medicaid are in the South and have a higher proportion of Black residents, Black women will benefit significantly from these Medicaid expansion efforts.
The time for states to act is now. The American Rescue Plan’s incentives for states to expand Medicaid, which provide enhanced federal dollars for two years after expanding, comes off the table as soon as March 2022. The opportunity to expand postpartum coverage starts in April 2022 and would be available for five years, but we shouldn’t wait—too many mothers are dying unnecessarily.
Mothers everywhere—and the people who love them—also have a role to play. We can all push states to expand their Medicaid programs through our own advocacy. Each state requires its own strategy for Medicaid expansion. Some states can do ballot initiatives, others need the state legislature to act. Organizations like Community Catalyst and U.S. of Care know the local landscapes. The rest of us can support these organizations that help citizens in those states to get it done.
Making sure all mothers in the U.S. have health insurance will take an ongoing effort. It’s more than an election-year issue, and we can provide this critical support now. Mothers deserve no less.
Rosemarie Day is the Founder & CEO of Day Health Strategies and author of Marching Toward Coverage: How Women Can Lead the Fight for Universal Healthcare (Beacon Press, 2020). Follow her on Twitter: @Rosemarie_Day1
Deborah Gordon is author of The Health Care Consumer’s Manifesto: How to Get the Most for Your Money (Praeger, 2020) and an Aspen Institute Health Innovators Fellow. Follow her on Twitter: @gordondeb
The authors greatly appreciate the research contributions of Allie Dawson, MPH (Consultant at Day Health Strategies) to this piece.