Dems, GOP Want to Expand Medicaid Postpartum Coverage
House lawmakers are pushing a bill that would make it easier for states to provide Medicaid coverage to new mothers for a longer period of time, in the hopes it will curb the rate of women dying from complications after giving birth.
Democrats and Republicans often don't agree on who should be covered by Medicaid, which provides health care for low-income individuals. But the number of women experiencing pregnancy-related health problems—killing 700 women per year—has brought lawmakers to the table to look for ways to improve access to and quality of postpartum care.
House Energy and Commerce Health Subcommittee members agreed on Wednesday to move forward with legislation that would create a streamlined process for states to expand Medicaid coverage for new mothers up to one year after they give birth. The legislation would also temporarily provide more federal dollars to states that choose to take up this option.
The current federal cutoff for Medicaid coverage is 60 days postpartum, and experts warn that this could leave women without access to needed care.
Supporters of the legislation told National Journal the policy would help women maintain health care coverage during a time when they could face complications related to their pregnancy. Centers for Disease Control and Prevention data shows that a third of pregnancy-related deaths occurred one week to one year after the mother gave birth.
"If you're in a state that has not expanded Medicaid through the [Affordable Care Act] and you are only qualified for Medicaid due to pregnancy, you're likely to roll off of Medicaid at 60 days postpartum, which is a problem if deaths are occurring between 60 days and a year postpartum," said Kathryn Schubert, chief advocacy officer at the Society for Maternal-Fetal Medicine.
"The idea to extend Medicaid for up to a year is to be able to have that continuous coverage, follow-up on postpartum care that's really necessary and be able to prevent those deaths that are preventable," Schubert added.
Nearly half of women living in states that didn't expand Medicaid to cover more people under the ACA—those living at up to 138 percent of the federal poverty level—experienced coverage disruptions from pre-pregnancy to postpartum, according to research published in the Health Affairs Blog in September. One in three women living in Medicaid-expansion states also experienced coverage lapses, the research showed.
The legislation that was advanced on Wednesday was a result of a compromise between Democrats and Republicans to keep the decision over whether to expand Medicaid postpartum coverage with the states. An earlier proposal spearheaded by Rep. Robin Kelly would have made the one-year Medicaid postpartum extension a required change for all states, instead of an option, but that measure had only Democratic cosponsors.
Under the compromise legislation, lawmakers would create a new pathway to allow states to amend their Medicaid programs specifically to expand coverage for mothers up to one year.
The bill that was advanced out of the Health Subcommittee was sponsored by Kelly and subcommittee ranking member Michael Burgess, along with other Democratic and Republican members.
"We can't allow the perfect to be the enemy of the good. This is a strong, bipartisan first step, to protect mothers and preserve families," Kelly said in a released statement following the hearing.
Burgess said he thinks this legislation is politically viable to get through Congress and be enacted into law. "I wanted the best policy that fiscally, structurally and politically could make it to the President's desk," Burgess said in a statement to National Journal. "Republicans and Democrats agreed it was my legislation with Rep. Kelly that will make that happen."
Some experts said the compromise could mean not as many women would obtain coverage. "It really is striking how, as states are given these options, that we continue to create two Americas for coverage," said Adam Searing, associate professor of the practice at the Georgetown University McCourt School of Public Policy's Center for Children and Families.
"There is no question in my mind that making it a state option will mean that women in the majority of states will benefit," Searing added. "There will be a minority of states … where women are not afforded the same affordable health care options that they are in the rest of the country."
But the legislation could be built upon to eventually make the proposed Medicaid expansion a requirement for all states, said Lucia DiVenere, officer of government and political affairs for the American College of Obstetricians and Gynecologists.
For now, DiVenere said, the bill would make the process easier for states that want to expand their Medicaid programs for new moms. Currently, states typically seek a waiver that must be approved by the Health and Human Services Department in order to extend postpartum coverage past the 60-day cutoff, experts said. DiVenere said this can be a burdensome process.
With the legislation, "it's a whole different pathway; it's an easier pathway," she said. "It provides an incentive to do what so many [states] have been exhibiting that they are really interested in doing, and we're really optimistic about this being a really good first step.