Congress is in the midst of negotiating the $3.5 trillion social infrastructure package. Sights are set on expanding critical social supports such as child care, economic relief, tackling the climate crisis, health care coverage, and more. Maternal health advocates (myself included) also have their sights set on advancing key policy priorities that will help address America’s maternal health crisis. If passed, these initiatives could change the trajectory of this burgeoning public health concern—one that continues to most harm Black women at alarming rates.
Black women are approximately three times more likely to die of pregnancy-related causes than white women. And while a multitude of factors contribute to these largely preventable deaths, racism and inequality greatly exacerbate the likelihood of Black mothers experiencing maternal mortality and severe maternal morbidity. However, sound public policy that is developed and implemented in ways that center Black women and their lived experiences can help remedy some of the disadvantages associated with racism and inequality in health care. The Black Maternal Health Momnibus Act, postpartum Medicaid coverage for one year, and access to doula care are just a few of the maternal health policy priorities advocates are seeking to advance via reconciliation.
The Black Maternal Health Momnibus Act
The Black Maternal Health Momnibus Act is the most comprehensive legislative effort to date to address both clinical and non-clinical drivers of America’s maternal health crisis. The package of twelve bills centers the lived experiences of Black women and elevates evidence-based measures aimed at advancing health equity, such as addressing the social determinants of health, funding for community-based organizations, providing care and support for incarcerated moms, growing and diversifying the perinatal workforce, protecting moms and babies against climate change, addressing maternal mental health, and other important investments. Advancing this transformative legislation through reconciliation not only would send a clear signal that we are serious about tackling our nation’s maternal health crisis, but also would set the country on the path to adequately addressing it once and for all.
Mandatory Extension of Postpartum Medicaid Coverage
As an important initial step in efforts to advance maternal health equity, the American Rescue Plan Act included a time-limited option for states to extend postpartum Medicaid coverage to one year. The next round of reconciliation provides a new opportunity to build on this critically important effort and pass a policy that permanently ensures that every mother in every state can be guaranteed comprehensive Medicaid coverage for a full year postpartum. TCF’s research has shown that losing coverage just sixty days after giving birth—which is the current standard under the pregnancy pathway of Medicaid—causes financial strain on women and families; disrupts continuity of care (which can be gravely harmful for high-need mothers and those with chronic health and social needs); and perpetuates racism, bias, and inequality in the health care system. Black women and other women of color make up a disproportionate share of Medicaid enrollees, so this policy solution is critical to the advancement of maternal health equity.
Doula Care and Support
Doulas are trained, non-clinical professionals who provide continuous physical, emotional, and informational support to pregnant and birthing people. Community-based doulas are trained in culturally congruent models of care that serve to meet the unique needs of Black women and families, who have historically experienced trauma within the health care system, as well as adverse health outcomes. Studies show that the support of a trained doula can be a lifeline, not only in the health care setting, but also during the sensitive postpartum period for a new mother and her family. The benefits associated with doula care are even more pronounced for low-income women, single mothers, and those experiencing other social and structural determinants of maternal health inequities. Congress can help advance maternal health equity by creating a pathway for better access to doula care, such as requiring coverage through Medicaid with reimbursement rates that allow community-based doulas to earn a living wage. The Mama’s First Act would mandate Medicaid coverage of doula care, while legislation such as the Health MOMMIES Act could serve as a model for ensuring adequate reimbursement rates for doulas.
Other Health Care Priorities
Congress is also considering additional policy efforts to ensure Medicaid expansion for the more than 2 million people who would qualify, but are currently ineligible because they live in the remaining twelve states that have declined to expand Medicaid under the Affordable Care Act. These states are largely concentrated in the South, where about half of the Black population lives. The plan could entail implementing a new federal coverage program that would ensure coverage for those people who fall within the coverage gap. There is also a push to make permanent the expanded tax credits on private health insurance for those purchasing coverage through the ACA marketplaces, as seen in the temporary fix included in the American Rescue Plan Act. As previously reported by The Century Foundation, Medicaid expansion not only ensures better coverage options and comprehensive care for pregnant and postpartum people, it also helps ensure better maternal and infant health outcomes. Furthermore, Black women and other women of color are more likely to fall within the coverage gap, making expansion an essential component in the advancement of maternal health equity.
The next reconciliation package presents a unique and timely opportunity to advance some of the most critical investments in maternal health equity. As the developed country with the worst maternal health outcomes, it is of the utmost importance that the United States seize the moment. And Black women in particular can no longer wait for some of our nation’s policymakers to finally decide that Black lives are valuable. The time is now to pass concrete, evidence-based policy solutions that will address America’s burgeoning maternal health crisis.