Congress must permanently extend postpartum Medicaid coverage

In the hours, days and weeks after childbirth, women should be bonding with their newborns and watching them thrive and grow. Yet the United States is one of the most dangerous developed nations in the world in which to give birth, despite our world class health system and our high per capita spending on health care. Seven hundred women die in the United States each year from causes related to pregnancy, and around 50,000 suffer from severe complications, like heart attack, kidney failure and shock, that can impact their health and even disable them for months. One in 5 women are affected by anxiety, depression and other maternal mental health conditions during and the year following pregnancy.

And some women have more to fear. Black and American Indian/Alaska Native women are 2-3 times more likely to die from pregnancy related complications compared to White women.

We can prevent most pregnancy-related deaths by ensuring women have continuous access to health care before, during and after pregnancy. Yet today, many of our most vulnerable moms spend most of the first year after childbirth — when they are still at risk of complications and even death — with no or unstable health care coverage. An important first step toward ending the maternal health crisis is this: Congress must pass legislation that permanently extends Medicaid coverage through the first year after a woman welcomes her child into the world.

Nearly half of all U.S. births are paid for by Medicaid, and Congress has taken a positive step in the right direction by passing the American Rescue Plan Act of 2021, which includes an option for states to extend postpartum coverage from 60 days to 12 months. It is a huge improvement. Some states, like Illinois, Missouri and New Jersey, are already working to provide coverage to low-income women for a year after birth, and the new option will make it easier for states to ensure women can benefit from continuous coverage.

But the provision is not enough, and it will only last five years. Bolder action is needed at a time when the COVID-19 pandemic is disproportionately impacting Black, Latino and Native Americans, and the maternal mortality rate of Black women is abysmal.

Making this policy mandatory on a permanent basis is a matter of urgent health equity, and a matter of science. Congress established 60 days of post-birth Medicaid coverage for pregnant women 35 years ago, and since then the number of women per 100,000 who die related to pregnancy has more than doubled. At the same time, today we know much more than we did in 1986 about the importance of continuous health care coverage and care before, during and after pregnancy.

Losing health insurance is among the factors that lead to the deaths of pregnant and post-partum women — as are not knowing about warning signs of pregnancy complications, having inadequate access to care and receiving delayed diagnoses, all of which can be associated with a lack of coverage. Extending Medicaid coverage, so that women don’t lose insurance during that important year after birth, will promote health equity because women with Medicaid coverage when they deliver their babies are more likely to be Black than are women who have private insurance.

Not only will this policy promote continuity of care and simplify women’s lives by not requiring them to navigate insurance while they are juggling the demands of new motherhood, it will also save the government money. Women who are eligible for Medicaid because they are pregnant often re-enroll later. A lapse in insurance coverage can mean these women are sicker when they regain coverage. Extending postpartum coverage will keep them healthier, and therefore reduce costs to the Medicaid program. Keeping people from moving in and out of Medicaid also boosts preventive care and means fewer hospital admissions and ER visits.

Extending Medicaid postpartum coverage isn’t the only thing we need to do to solve the maternal health crisis. But it’s an important foundation for other much-needed steps like eliminating racial and ethnic health disparities and driving economic, social and health equity, closing other gaps in coverage and care, and expanding research and improving maternal morbidity and mortality data collection.

It should not be optional for states to ensure every woman gets the coverage she needs to stay healthy — and alive — after their babies are born. Congress must make one year of Medicaid coverage after birth a permanent, mandatory policy across the nation. Let’s move closer to ending the maternal health crisis by making the year after she gives birth a time filled with joy for every woman in America.

Stacey D. Stewart is president and chief executive of March of Dimes.