We must close the Medicaid coverage gap to save Black mothers
by Rep. Robin Kelly and Rep. Val Demings
Across the United States, women die of pregnancy-related complications at a higher rate than in any other similarly large, wealthy country in the world. Expanding Medicaid will save the lives of women and babies and save money in our health care system. But the two states that we represent in the U.S. House of Representatives – Illinois and Florida – have taken very different approaches to this national crisis.
Illinois chose to accept federal funding to expand Medicaid. Florida’s leaders have refused. As a result, we have seen a stark contrast between our two states: one in which pregnant women and new moms are able to access critical health services, and one in which moms are told, “you’re on your own.”
Let’s be clear about the impacts. A major study last year found that expanding Medicaid was “significantly associated with lower maternal mortality.” Simply put, expanding Medicaid saves the lives of America’s moms.
Black women are at the center of this crisis. They’re three times as likely to die and twice as likely to experience severe maternal morbidity. These disproportionate impacts are rooted in structural racism and transcend factors like education and income. Access to care is a huge part of the problem.
Medicaid paid for 65 percent of births to Black women in 2019, but hundreds of thousands of American women have no Medicaid access. This is because of what’s called the “Medicaid Gap” – a flaw in our laws that places millions of people in a financial bracket where they are “too poor” to access the private insurance marketplace, and “too rich” (though still living essentially in poverty) to access Medicaid. For years, we have been pushing for a Medicaid expansion to cover these individuals, which will not only save lives but also bring down health care costs across the board.
However, until now, each state has had the option to “decline” the funding that we already passed to cover this expansion. And tragically, 12 states, including Florida, have rejecting this lifesaving funding.
In 2019, 2.2 million uninsured people — including more than 800,000 women of reproductive age, two-thirds of whom are people of color — lived in these states. They have no pathway to affordable health care coverage because their states refuse to expand Medicaid. That means they miss out on important preconception care, including counseling and prescriptions for specific treatments that can reduce birth defects and screenings that could identify and treat conditions associated with poor pregnancy outcomes. They also would be more likely to get timely prenatal care.
Medicaid covers pregnant women in all states with incomes below 133 percent of the poverty line, and many states go higher. However, that coverage doesn’t start until someone knows they are pregnant, applies for Medicaid, and is found eligible. By that time, they have likely missed out on the care they need in those first few critically important weeks of pregnancy. We know from decades of medical research that consistently, life-long care is critical to the health of mothers and their children.
The American Rescue Plan Act, which we passed to provide critical COVID-19 relief to families and small businesses, also included a new option for states to extend pregnancy coverage for 12 months after pregnancy ends rather than the 60 days allowed under current law. Illinois was the first state to extend full Medicaid coverage for one full year postpartum. All states should take that up, but many won’t. We should go even further.
In the reconciliation package currently being constructed by Congress (which both of us have supported), we must include a requirement that states permanently extend Medicaid coverage for postpartum services. Collectively, closing the coverage gap and providing mandatory Medicaid postpartum coverage will ensure the continuity of care through pregnancy and postpartum stages. This will save lives. Anything less will exacerbate existing maternal health disparities. We have no choice but to act.
It’s time for Congress to close the Medicaid coverage gap so all people, particularly the women and babies at the highest risk, have access to the healthcare they need.
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Rep. Robin Kelly represents Illinois’ 2nd Congressional District and serves as Chair of the Congressional Black Caucus Health Braintrust, Co-Chair of the Caucus on Black Women and Girls and as Vice Chair of the Energy and Commerce Committee.
Rep. Val Demings represents Florida’s 10th Congressional District. She is a former social worker and police officer, including Orlando, Florida’s first female Chief of Police.
Read the original at The Chicago Tribune.