A 'New Normal' Can't Leave New Mothers Behind

As severe COVID-19 case rates fall and the nation moves towards a "new normal," the same cannot be said for America's maternal mortality crisis.

In a recent report, CDC found that the U.S. maternal death rate continues to climb--jumping 14% from 2019 to 2020. Pregnancy-related mortality has long been a sore subject for the U.S. healthcare system. Not only do we have the highest maternal mortality rate among developed countries, but non-Hispanic Black mothers die at three times the rate of non-Hispanic white or Hispanic mothers.

While pregnancy and labor carry their own risks, the majority of pregnancy-related deaths occur after delivery, known as the "postpartum" period. The CDC has pointed to high quality postpartum care as key to lowering maternal death rates. However, obtaining quality care during this period can be challenging, especially when our health insurance system often leaves vulnerable mothers uninsured right when they need care the most.

Medicaid pays for almost half of all pregnancies in the U.S. Current federal legislation requires Medicaid to cover pregnant patients with incomes less than 138% of the Federal Poverty Level (an average of only $18,754 in income per year) through their pregnancy and 60 days after delivery. After those 60 days, many new mothers (especially in states that did not expand Medicaid under the Affordable Care Act) become uninsured.

The 2021 American Rescue Plan Act created a temporary option for states to expand Medicaid coverage to mothers for 12 months after childbirth. Several states have already implemented this extension--but many others have not. The current Build Back Better Act, if passed, would require all states to permanently cover the full 12 month postpartum period in their Medicaid programs.

As frontline doctors treating high numbers of underserved patients, we are far too familiar with mothers falling through the cracks in our nation's health system. While we consider caring for new mothers and their families a privilege of our profession, all too often we see our patients struggling to find timely care or afford their medications, or delaying care due to insurance limitations.

Having witnessed these barriers firsthand, we strongly support the permanent extension of Medicaid to 12 months postpartum. Specifically, we believe that extending postpartum Medicaid would lead to three positive outcomes.

First, postpartum Medicaid extension would improve the long-term health of U.S. mothers. The physical effects of pregnancy and the increased contact with healthcare providers during prenatal care often leads to the discovery of chronic medical conditions among women, such as high blood pressure, diabetes, heart disease, clotting disorders, and depression that require treatment and monitoring after delivery. Moreover, mothers who suffered from severe COVID-19 disease during pregnancy can have long-term complications. Supporting a mother through the entire year-long postpartum period is essential strategy to improve mothers' overall health.

Extending Medicaid coverage after childbirth would also begin to address our country's flagrant health inequities. Black, indigenous, and Spanish-speaking patients have the highest uninsured rates after delivery. This results in coverage gaps for essential health services, such as access to preventive care, contraception, mental health services, and management of chronic health conditions. Increasing healthcare access for postpartum mothers represents a crucial strategy to address these systemic health disparities.

Lastly, the impact of pregnancy on mental health cannot be overstated. One in 10 postpartum patients meet the criteria for major depression. In one study, 46% of postpartum depression cases occurred more than 2 months after birth, a period that would not be covered without an extension of postpartum Medicaid. Recent studies found that the COVID-19 pandemic increased rates of maternal depression and anxiety, leading to negative effects on mother-infant bonding. With Medicaid being the single largest payer for mental health services in the U.S., extending Medicaid postpartum coverage to 12 months would provide a critical path to treatment for these mothers.

We are physicians because we believe in caring for people regardless of their insurance status, but our nation's current insurance structure forces many mothers to forgo needed care--and pay with their lives. This does not need to be the case. Access to healthcare after childbirth not only improves the health outcomes of mothers, but also, the health of their infants and families. While policymakers continue to debate the President's health priorities, Congress and the administration should stand by the postpartum Medicaid extension to protect the lives of our nation's most vulnerable mothers and their families.

Emmeline Ha, MD, is a family medicine physician and health policy research fellow at the Center for Professionalism & Value in Health Care and the George Washington University. Sydney Doe, MD, is a resident family medicine physician at the McGaw Northwestern Family Medicine Residency at Erie Family Health Centers and visiting health policy scholar at the Center for Professionalism & Value in Health Care. Marisa K. Dowling, MD, MPP, is a Clinical Assistant Professor at the George Washington University Department of Emergency Medicine.