With the pandemic highlighting health disparities in the U.S., maternal health advocates think this will be the year Congress takes bold action to end preventable, pregnancy-related deaths that disproportionately impact people of color.
Black women are three times more likely to die pregnancy-related deaths than white women, and Black people are two times more likely to die of COVID-19, according to the Centers for Disease Control and Prevention. Those issues are likely compounding each other, experts say.
"Maternal health should be a part of the COVID response because it is a problem that's been exacerbated by the pandemic," said Jamille Fields Allsbrook, director of the women's initiative at the Center for American Progress.
A package of bills called the "momnibus," introduced by Rep. Lauren Underwood (D-Ill.), co-chair of the Black Maternal Health Caucus, seeks to address several issues affecting maternal mortality, including social determinants of health, growing and diversifying the perinatal workforce, improving access to midwives and doulas and improving data collection, among other things.
"There's no one thing that got us into the maternal health crisis," except for racism, Fields Allsbrook said. "This bill is meant to be a robust response to a decades old problem that has long existed."
The U.S. has the highest maternal mortality rate among developed nations. While maternal deaths have have been decreasing in other countries for several years, they have increased in the U.S. since 2000 with women of color, particularly Black and indigenous people, bearing the brunt of the problem. Experts broadly agree that maternal mortality is affected by a lack of access to healthcare, either because people are uninsured, live in parts of the country without hospitals or birth centers, or both.
Institutional racism in the healthcare system leads to women of color not being taken seriously when they raise concerns about their pregnancies and health. Black women are more likely to have underlying health conditions that complicate pregnancies, like heart disease.
Underwood, a nurse, told Modern Healthcare she's optimistic about at least some of the bills passing and has had "productive conversations" with Senate Democratic leadership. With Democrats' slim majority in the Senate, most bills will need the support of at least 10 Republicans to pass. Many of Underwood's bills have received more bipartisan support this year than the first time they were introduced last year, she said.
"The key for me is about saving lives period and however we can accomplish that, I am willing to work with whomever — Democrat or Republican, administration officials, and we have our industry and stakeholder partners as well," Underwood said.
She's also "aggressively" reaching out to the Biden administration finding parts of her bills that can do through executive action.
With Democrats in control of the House, Senate and White House for the first time in several years, it appears that substantial action on maternal health is imminent.
"We're hopeful Congress and the new administration will use this opportunity they have now to pass something significant and structural and act on their promises during the campaign on health equity and racial justice more broadly," said Jane Sheehan, director of federal relations at Families USA.
The House last year passed a bipartisan maternal health bill introduced by former Rep. Eliot Engel (D-N.Y.), but the proposal never got a vote in a Senate committee. It would create new grant programs for the training of maternal care providers in rural areas and establish rural obstetric networks focused on improving maternal health outcomes.
"This should be at the top of the list to be enacted as quickly as possible," said Rachel Gandell Tetlow, director of federal affairs for the American College of Obstetricians and Gynecologists, noting that it has been heavily vetted through committee hearings and votes last year.
But another related measure was included in the $1.9 trillion COVID-19 relief bill passed this month. Starting next April, states can choose to extend Medicaid coverage for one year postpartum. Previously federal law only allowed coverage to extend for 60 days.
About one-third of maternal deaths happen between one week and one year after childbirth, endangering mothers who lose Medicaid coverage two months postpartum, experts say. Cardiac disease, diabetes and other issues can complicate pregnancies are often not resolved after childbirth. Increasing cases of postpartum depression or substance use after pregnancy are also concerning.
"It is not automatic that six months after delivery, those things go away," said Dr. Rahul Gupta, chief medical and health officer for March of Dimes. "We believe it's critical to have the ability to promote care for at least 12 months."
Several states previously considered extending postpartum Medicaid coverage through federal waivers. Under the new provision, states can make the optional change for five years.
Lobbyists and advocates plan to push Congress to make the change mandatory and permanent for states.
The Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises Congress and Medicaid issues, this week recommended Congress extend the postpartum coverage period for Medicaid for a full year, regardless of changes of income, noting that inadequate care after pregnancy may contribute to racial and ethnic disparities in maternal health outcomes.
The extension of postpartum Medicaid coverage would be particularly beneficial in states that haven't expanded Medicaid to low-income adults under the Affordable Care Act. In Texas, a married mother with a newborn will lose Medicaid coverage two months after giving birth if the household annual income exceeds $3,733, according to the Kaiser Family Foundation.
"It is important to note that the federal policy of covering postpartum care for only 60 days is not rooted in modern medical knowledge and does not reflect needs attendant to pregnancy that extend well beyond this period," MACPAC's report reads. "Women may experience risks to their lives postpartum, with almost 12% of maternal deaths occurring in the late postpartum period, and a considerable share of these deaths are potentially preventable."
