Patrice Lott, 37, suffered a miscarriage in 2020, a plight that affected her both physically and emotionally.
Because she was covered by Medicaid under a COVID-related policy, she was able to receive medical care and counseling, both of which paved the way for her subsequent pregnancy, through which she carried to term her daughter, today a thriving toddler.
Lott, who is Black and thus at increased risk of getting sick or dying from pregnancy-related issues, developed gestational diabetes during her pregnancy, a condition that must be regularly monitored.
She also has chronic asthma that is controlled by physicians she sees through her Medicaid health insurance, enabling her to be present to her family — she also has a 15-year-old — and to work as a cosmetologist.
“Medicaid allowed me to be able to be there and take care of my children,” said Lott, who lives in Austin.
Stories like Lott’s stand to have happier endings now that a bipartisan piece of legislation in Texas was passed, signed by Gov. Greg Abbott and transformed into law.
House Bill 12 extends Medicaid postpartum medical coverage to a full 12 months, a more generous policy than the current 60 days of care after the birth of the child.
What a nice change of pace.
Readers of this space know that I’m not a huge fan of the Texas Legislature, regularly decrying the stinking jurisprudence that so often emanates from Austin. From the outright banning of most abortions in Texas in the wake of the Supreme Court’s Dobbs decision to the many ways our Republican leaders have short-changed children in this state to, most recently, the move to outlaw gender-affirming care for transgender minors, the merry band of ideologues at the Capitol seem hell-bent on making Texas a cesspool of bad laws that disproportionately hurt women, children and the marginalized, especially LGBTQ folks.
But sometimes, you have to give credit where credit is due.
During its last session, the Texas Legislature voted as a near-unanimous block to extend the federal-state health insurance for low-income mothers to a full year, and now untold numbers of women and their children will benefit immensely from such care.
Common wisdom (or lack thereof) holds that the dangers of pregnancy and birth simply evaporate once the baby arrives, but that couldn’t be further from the truth for many women.
According to a recent study by the Centers for Disease Control and Prevention, a whopping 30% of maternal deaths occur after a baby turns six weeks old and up until the baby’s first birthday.
Along with death, other serious postpartum health complications include hemorrhage, stroke, heart problems and infections, all of which can put a woman’s long-term health in jeopardy and complicate her ability to care for her children.
What’s behind the dire numbers are public health epidemics like obesity, mental health and substance use disorders, untreated chronic health conditions like diabetes and the dark sequelae of systemic racial discrimination.
Violence is also implicated in many pregnancy-related deaths, especially intimate partner violence.
The hormonal maelstrom that is pregnancy can also wreak havoc on a new mother’s mind and mood, particularly if she was experiencing anxiety, depression or other mental health disorders prior to pregnancy.
The odds of Black women like Lott suffering a death related to pregnancy and birth are more than twice that of white women, and four times that of Hispanic women.
In December, a long overdue report on Texas maternal mortality finally came out. It revealed that women without private-pay health insurance had the highest rates of death related to pregnancy, with a quarter of those deaths happening between 43 days and one year after childbirth.
The committee reviewed 118 maternal deaths in the state in 2019 and found 52 were pregnancy-related, 42 were pregnancy-associated, but not related; and 24 cases could not be determined.
It found that 90% of the pregnancy-related deaths were preventable — that is, there was at least some chance of saving the mother’s life if medical care had been involved.
In Texas, suicide and homicide represented 27% of pregnancy-related deaths, most commonly through firearms or airway restriction, such as hanging, strangulation and suffocation.
Hopefully some of these horrific statistics will improve with the longer access to care.
Pregnant women on Medicaid in Texas — more than 4 in 10 births in the U.S. are covered under the program — will be able to receive the kind of medical care that not only prevents such disasters, but guards against ongoing chronic conditions that hamper their ability to live healthy lives.
The current 60 days’ worth of postpartum Medicaid care is “not a lot of time to deal with any health concerns the mother had coming into pregnancy and after pregnancy,” said Evelyn Delgado, president and CEO of Healthy Futures of Texas. She also chairs the Texas Women’s Health Care Coalition, an 89-member group that advocates for access to preventive health care for Texas women.
The extension of Medicaid postpartum care “is a wonderful opportunity for women to improve their health and be able to be there for their children and also to be healthier if they decide to have another child,” she said.
Delgado said many women whose pregnancies are covered by Medicaid work at low-wage jobs that don’t provide health insurance. They may struggle with transportation issues, live in healthy food deserts and operate under the burden of poverty and the myriad ways it manifests in our society. She and other women’s advocates, who are “ecstatic” about the new policy, hope it will be fast-tracked for approval by the federal government.
To our shame, the U.S. has the highest maternal mortality rate in the developed world, when you count deaths that happen during gestation and up to six weeks after delivery. During the COVID pandemic, those numbers rose to 32.9 deaths for every 100,000 live births in 2021, up from 20.1 deaths per 100,000 live births in 2019.
At least eight states this year have made the move to extend Medicaid care post-pregnancy.
In addition to Texas, 41 others states (including Washington, D.C.) have already implemented 12-month postpartum coverage or are working on its implementation. Most of the remaining states have Medicaid expansion in place.
Studies have shown that in Bexar County, the health care cards are not on the side of poor women of color, who on average receive less prenatal care and post-natal care, said Delgado.
The CDC data showed that the main causes of maternal deaths among Latina mothers nationally involve mental health conditions that can result in suicide or drug overdoses.
Among white women, mental health conditions are responsible for 35% of pregnancy-related deaths; for Hispanic women, the figure is 24%.
That Texas chose to extend Medicaid postpartum care would seem like a no-brainer, given the lack of reproductive rights across the state in the post-Dobbs landscape.
After all, if Abbott and his allies in Austin are going to force women to give birth, the least they could do is provide the level of medical care that will help keep them alive.
It’s one thing to talk about loving the unborn, quite another to provide the funding that will preserve the health of mothers once a child enters the world — which, of course, affects the wellbeing of those selfsame children.
All of the eight votes against the Texas bill were from Republicans.
The extension of Medicaid for mothers comes as the state is contracting coverage for others, as COVID-related emergency care comes to an end.
Texas is one of 11 states that has declined to expand Medicaid under the Affordable Care Act, leaving billions in federal funds on the table and granting us the dubious honor of having the largest uninsured population in the nation.
Most states moved to full-year coverage right after the U.S. Supreme Court overturned the right to abortion. We’re laggards, as usual.
But, hey, at least we’re not Arkansas, which failed to pass a one-year postpartum expansion legislation this year despite having the nation’s highest reported maternal mortality rate, according to the CDC.
Texans Care for Children, an advocacy group, celebrated the new policy but noted that most Texas women who fall below the poverty line still will not have access to health coverage before their pregnancy, during the Medicaid application and approval process in their first trimester and once their 12-month postpartum coverage ends.
In states (unlike Texas) that have expanded Medicaid coverage, those women would be covered during those times.
According to one dashboard, nearly half of low-income Texas women of childbearing age do not have health coverage, ranking Texas 50th in the nation.
Still, let’s call this outcome for what it is: Something progressive has happened in the backward Lone Star State.
“I’m thankful the [Legislature] listened to us,” said Lott, who testified before lawmakers in defense of the postpartum bill. “Just knowing you can take care of yourself brings such peace of mind. A lot of women are going to be helped by this.”
