This letter first published online at NC Policy Watch.
This Mother’s Day, new North Carolina mothers are receiving an unexpected gift thanks to President Biden’s American Rescue Plan (ARP), the federal relief bill that provides for an additional 10 months of postpartum healthcare for women who give birth. Currently, pregnant women covered by Medicaid get coverage for only 60 days after birth, even though most maternal deaths happen not in childbirth, but in the first year after birth.
The ARP relief package is opening up new opportunities for millions of people who’ve been struggling through the pandemic without healthcare, income and jobs to get the help they need to recover from COVID. In addition to extended unemployment benefits, more money for public education, free testing and vaccinations, and direct cash payments to 85% of households, the package also provides more funding for Medicaid services like coverage for the uninsured, expanded home and community-based care, and maternal health care.
This is all great news for new mothers who now receive Medicaid, but not for those who would also be eligible if our state had already expanded Medicaid. There is a proposed bill in the North Carolina Senate (SB 530) that would expand Medicaid coverage to new mothers, but only to new mothers, and only for one year. Limiting expanded eligibility just to them, and just for this limited period of time, rather than extending it permanently to the 500,000 North Carolinians who would benefit from a full expansion, would be misguided and wrong, especially in light of the generous financial incentives the ARP offers our state and others that have not yet expanded Medicaid.
We hear and read of talk at the General Assembly that Medicaid expansion could be a possibility this session. That would be great news for moms and their babies, particularly for low-income families and for women of color, who are more likely to have complications in pregnancy and childbirth than their white counterparts. The United States has the highest rate of maternal mortality in the Western world.
Over half of pregnancy related deaths occur within the first year after birth. Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women according to the Centers for Disease Control (CDC). Black women have the highest rate of maternal mortality of any group.
As a single mother who has chronic congestive heart failure myself, along with other health issues, and two children diagnosed with mental and physical health challenges, I know that Medicaid has always been a critical program for moms and for their babies, and especially for Black mothers. My life, and my children’s, literally depends on my staying healthy. Medicaid has helped the three of us survive at times when we needed it, but there are so many who still need it and are denied.
Medicaid is particularly critical for moms and kids. Medicaid is the leading payer of family planning services in the United States and finances the greatest number of births of any insurer. Fifty-four percent of births in North Carolina are financed through Medicaid.
But Medicaid coverage for pregnant people after birth has historically been limited to 60 days even though rates of maternal mortality have steadily increased over the past decade. North Carolina ranks 30th among state in maternal mortality. Lack of access to healthcare and to prenatal care, especially for Black women, is a prominent driver of this tragic statistic. Postpartum care for new moms is a good first step toward ensuring that more women have the healthcare they need to have healthy pregnancies and births.
Research shows that when parents have consistent health coverage, overall health outcomes for the whole family improves and economic security increases. But social determinants of health like clean air and water, affordable housing, good paying jobs, paid leave and affordable childcare are also important factors in health outcomes. In addition to the relief package that has already passed and is being implemented, the upcoming federal stimulus packages are essential not just for substantive economic recovery, but for building back better in ways that actually address long-standing inequities and dated policies that have historically left women and people of color behind.
President Biden said in his first address to Congress, “Health care should be a right, not a privilege in America.” Every mom in America wants the best for her children and family. That goal is within reach but lawmakers at every level must take action that enables everyone to get affordable coverage no matter where they live, what they look like or their income. We will not build back better by leaving millions of people behind.
It’s past time North Carolina Republican legislators end their Medicaid expansion blockade.
Tarsha Gunn is a member of Action NC’s Race and Gender Equity Initiative (RAGE)