Over the last few years, the media have reported many stories about mothers dying during childbirth. These stories are tragic and as a result, more focus has been placed on hospitals to address these causes. However, what happens in the hospital tells only half the story.
Take this real-life mortality story we encountered as an example. We’ll call her Maria, a young Philadelphia woman who had a long history of depression and multiple admissions to the hospital for suicide attempts. She found out she was pregnant and at the same time that she had HIV. With the help of her social worker, she attended all her doctor’s appointments and consistently took her HIV medications to ensure the virus wouldn’t transmit to her baby during her pregnancy. She had an uncomplicated birth and was discharged home from the hospital. Six months later, she committed suicide.
Sadly, stories like this one are not unique. In the United States, the number of women who die while pregnant — or within one year of the end of a pregnancy — is significantly higher than in other developed countries, with almost half those deaths occurring after hospital discharge.
There’s momentum now for Pennsylvania and other states to tackle this issue by making changes to their Medicaid plans to direct more support to women in the months after childbirth. In September, the U.S. House of Representatives — through bipartisan support — passed the Helping MOMs Act, which gives states a clearer path to ensure that Medicaid continues to support women in the year after childbirth.
Here’s why that’s so crucial: Approximately 4 in 10 births in the United States are paid for by Medicaid. However, for pregnant women, Medicaid coverage is time-limited. They lose coverage at 60 days postpartum and enter a period of uninsurance, even though their newborn is covered for a full year. Currently one-third of women experience a disruption in insurance coverage before, during, or after pregnancy. Lapses in insurance coverage and related systems of care issues have been identified as one of many contributing factors to our nation’s growing maternal mortality crisis. In addition to the negative health outcomes this causes for women, this also can result in serious developmental issues for a child.
In addition to being endorsed by more than 275 national and state-based organizations, extending Medicaid coverage beyond 60 days postpartum is a leading recommendation of state maternal mortality review committees and state departments of health. Maternal health experts in Arizona, Georgia, Illinois, Iowa, Louisiana, Maryland, Texas, Utah, and Washington have highlighted this policy as one solution among many to ending preventable maternal deaths.
Considering the pandemic and its magnification of health disparities, it’s crucial that we streamline access to maternal health care. According to the CDC, pregnant women with COVID are five times more likely to have severe disease requiring ICU admission, have an increased chance of preterm delivery, and are more likely to die than nonpregnant women in the same age group. These outcomes coupled with the fact that Black and Latino people are disproportionately affected by COVID will worsen existing racial disparities in maternal morbidity and mortality.
While our focus is on healthy outcomes for mother and child, it is important to note this policy will also make our health-care system more efficient. The average total per patient cost nearly doubles when a severe morbidity is present, so preventative care will decrease costs. Also, patients who lose coverage and then reenroll later usually do so with health-care complications that are costlier to treat. Last, it streamlines enrollment by removing the administrative burden of two separate redeterminations at different times based on continuous coverage for the child but not for the mother.
Having Medicaid coverage means having access to comprehensive medical and behavioral health services that are needed for effective prevention and treatment of underlying conditions and is a necessary step in addressing the maternal health crisis. As the U.S. Senate considers policies to address the maternal health crisis — especially now with the emergence of COVID-19, we strongly believe continuing access to Medicaid in the year after childbirth will have positive impact for mothers and families.
Aasta Mehta, MD, MPP, is Medical Officer of Women’s Health and Director of Philadelphia Maternal Mortality Review Program for the Philadelphia Department of Public Health. Morgan Cephas is a State Representative of the 192nd Legislative District in Philadelphia.