As an emergency medicine physician, I see firsthand the consequences of being a patient in America without health insurance. While the Biden administration previously addressed a key gap in insurance coverage known as the family glitch, other gaps remain, including Medicaid postpartum coverage. Additionally, recent attacks on reproductive rights in this country have left many concerned about the future of health care for people who choose to, and choose not to, have children. Improving access to all aspects of reproductive health care, including postpartum coverage, will increase patient autonomy and improve outcomes overall.
I have cared for countless patients who present with life-threatening conditions in the postpartum period. These conditions range from fatal infections to new heart failures, to postpartum depression and thoughts of suicide.
Many postpartum people experience complications that require immediate medical care in their “fourth trimester,” the critical period after birth. Unfortunately, many patients lack access to health care, a barrier to their ability to recover from these complications. This lack of access is a contributing factor to maternal mortality rates in the U.S. reaching crisis levels, which disproportionately affects patients with low incomes. While public health interventions like the ACA provision that created the Pregnancy Assistance Fund have taken a first step, we still lack adequate fourth-trimester interventions that increase access to care, decrease mortality, and promote health equity.
Extending postpartum Medicaid coverage would address these issues. Currently, Medicaid coverage for postpartum care only extends to 60 days after birth, leaving many mothers without proper care and support in the most critical period. Legislation signed by President Biden, such as the American Rescue Plan Act, has created a pathway for states to increase Medicaid coverage to 12 months. In fact, on April 1, 2022, over 700,000 children and postpartum people became eligible for coverage through Medicaid and CHIP as a result of this legislation. However, these fixes have been temporary and rely on states to participate. Thus far, only 24 states have adopted the ACA Medicaid expansion, leaving millions without coverage. Recently, 11 new states have demonstrated their commitment to expanding Medicaid and CHIP, but thousands of patients still remain without coverage. We need a solution that is universal and permanent. Proposals by the Biden Administration would permanently increase postpartum coverage from 60 days to one year for all Medicaid beneficiaries, a measure that would directly improve the maternal mortality crisis.
Pregnancy-related complications can be deadly. And unfortunately, many pregnancy-related deaths and complications occur outside the postpartum period currently covered by Medicaid. 33 percent of pregnancy-related deaths occur up to a year after birth, and 70 percent of postpartum people will develop a complication during the first year postpartum. But it does not have to stay this way. Three out of every five maternal deaths in the United States are preventable. As health care workers, we know that the best way to fix a complication is to prevent it from happening at all, which is only possible with expanding insurance so that all Americans can access adequate care promptly.
Additionally, expanding coverage would improve health equity. Maternal mortality is disproportionately distributed. People with lower incomes and less access to health care, for instance, have an increased risk of maternal death. The findings on income as a social determinant of maternal mortality further stress the importance of Medicaid coverage and improving health care access for all.
Public health officials and obstetric care professionals alike heavily emphasize the importance of fourth-trimester interventions in reducing maternal mortality and pregnancy-related complications. The maternal health crisis in the United States needs immediate attention and intervention to protect our patients and ensure their futures. Increasing Medicaid coverage for postpartum people from 60 days to 1 year would vastly improve the equity of maternal health care.
As we continue to think about ways to expand insurance coverage, expanding postpartum Medicaid coverage must be a priority. Our nation’s patients deserve better.
Kimi Chernoby is an emergency physician. Claire Dowell is a premedical student.
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