Far too often, the most medically vulnerable in our society lack access to affordable health coverage and therefore go without needed health care. New mothers represent one such group that faces extreme barriers to care despite their increased needs for medical care.
A recent report found that 11.5 percent of new mothers in the United States from 2015-2018 were uninsured; among those, about 20 percent chose to forgo needed medical care due to cost. The sample only included about 450 women, but is consistent with other studies. Other analyses have demonstrated a wide variation in access to insurance for postpartum women based on whether they live in a state that has expanded Medicaid or not.
Experts routinely cite lack of coverage before and after pregnancy as one of the reasons that the United States has high maternal mortality and morbidity rates and pregnancy associated deaths (which track mortality up to a year postpartum), relative to other industrialized nations. While missing a routine visit may not seem to pose a significant increased risk, any unmet health need could escalate to a life-threatening complication. For example, undetected or untreated high blood pressure during pregnancy can lead to preterm delivery or stroke in the mother. In the postpartum period, about 1 in 10 mothers experience depression, and the vast majority do not have access to care. In many cases, women must leave a prescription unfilled or avoid a mental health care visit.
Access to treatment and care remains even more critical in a pandemic that has taken over 200,000 lives, especially when researchers have yet to fully understand the virus’ impact on pregnant women. The economic fallout from the COVID-19 pandemic could further exacerbate these challenges. Millions have lost their jobs and the insurance coverage provided through their employer. The economic emergency has disproportionately burdened low-wage workers, such as those who work in hotels or restaurants, who did not have employer-sponsored coverage to begin with. They now find themselves in even more precarious financial situations, and struggle to meet basic needs such as paying rent and buying groceries. Women are more likely than men to work low-wage jobs, so it’s easy to see how these overlapping crises create even more barriers to health care, particularly for new mothers.
Policymakers interested in addressing this pressing and salient issue have several tools at their disposal. For starters, states or the federal government could pass a law increasing access to Medicaid for low-income postpartum women beyond the current 60-day threshold. Particularly in states that have not expanded Medicaid, this would greatly enhance the number of women eligible to receive care. For example, Texan parents must earn only 17% of the federal poverty line to qualify for Medicaid; for a single mom with one child, she would have to earn under $2,930.80 to qualify. This solution is easy to implement from an administrative perspective, as postpartum women are currently eligible for Medicaid benefits for two months and would not need to be re-enrolled.
Second, states or the federal government could allow postpartum women to sign up for coverage through the Affordable Care Act exchanges and provide additional subsidies to reduce some of the costs. This solution would be more geared toward women who make too much to qualify for Medicaid, but have lost household income or health benefits due to the economic crisis.
Looking at the forthcoming presidential election, the two candidates have taken different approaches to addressing myriad health insurance challenges, including uninsurance among new mothers:
President Trump’s most impactful policy agenda in this space has been to support a case before the Supreme Court, Texas v California, that would strike down the Affordable Care Act (ACA) as unconstitutional. Since the ACA’s passage in 2010 and the implementation of Medicaid expansion in 2014, a larger percentage of uninsured poor new mothers in expansion states gained coverage relative to those living in states that did not expand Medicaid. If the Supreme Court finds the entire ACA unconstitutional, all gains in coverage resulting directly from the heath law would disappear. It is difficult to calculate the magnitude of the damage and instability this action would cause, or to know what exactly would play out if only certain parts of the law are overturned. Despite repeated claims to the contrary, the administration has not revealed a policy agenda that would address coverage losses resulting from this lawsuit, and has yet to reveal any narrow plan addressing uninsurance among new mothers.
Former Vice President Biden, on the other hand, supports upholding and expanding the ACA, including introducing a public option that would allow people to purchase a government-run health insurance plan on the federal exchanges. This public option would also be available for free to individuals in states that have not yet expanded Medicaid. While this plan does not directly address uninsurance among new mothers and many would likely still fall through the cracks, thousands of low- and middle-income mothers could benefit from this coverage expansion. There is also a possibility that a Democratic trifecta in the House, Senate and White House would be able to pass a bill that has already passed the House, but stalled in the current Senate, that would extend postpartum Medicaid coverage for one year after delivery.
At this point in the Presidential election, there is no comparison as to which candidate would do more to improve new mothers’ access to health care: the Trump Administration is actively in court fighting to overturn access to care with no backup plan, while Vice President Biden has pledged to expand access to coverage.
Regardless of which candidate wins in just a few short weeks, new mothers need all the support they can get to thrive and help their children do the same. Expanding access to coverage would promote the health and well-being of both new mothers and their infants. Righting this wrong is within reach as long as our political leaders recognize our health system’s failures and swiftly act to fix them.