Medicaid coverage, especially for minority and low-income women, plays a key role in improving the health of moms and babies, according to a new report.
By looking at the difference between women’s insurance coverage and the health outcomes of moms and babies, researchers at Georgetown University Center for Children and Families show that states that have not expanded Medicaid have worse maternal and infant health outcomes compared with the states that have expanded Medicaid.
“The message of the study is clear. Medicaid expansion can protect the lives and help women and their babies, especially for women of color,” said Dr. Rahul Gupta, chief medical officer of March of Dimes, which contributed to the report. “We have a policy option at our fingertips that can reduce health disparities and save lives.”
The report shows that states that have expanded Medicaid, infant mortality rates have declined 50% more than non-expansion states. Also, in those states, the maternal mortality rates have dropped by 1.6 per 100,000 women and helped reduce racial disparities that are pervasive across the nation.
Black moms and babies are two to three times more likely to die within the first year after delivery compared with white moms. In states that have expanded Medicaid, that divide is narrowing.
“Medicaid expansion is providing one of the few examples of an intervention proven to address these disparities,” said Gupta. “Infant mortality has declined much more dramatically in states that expanded Medicaid and those declines were actually greater among African American infants, something we haven’t seen with any other kind of an intervention.”
The report’s findings are not good news for Florida, one of 14 states that have resisted Medicaid expansion.
In a nationwide comparison, Florida ranked in the bottom quarter in maternal and infant mortality rates in 2018, according to America’s Health Rankings. Black moms and babies in Florida continue to be more than twice as likely to die in the first year after delivery, compared with white moms.
“It seems like Florida’s women and children are our real victims,” said Anne Swerlick, senior health policy analyst at the Florida Policy Institute, hoping that the report can serve as an impetus for policymakers to consider expanding Medicaid. “If we’re going to be a family-friendly state, one of the key things we need to do is to support families.”
Rep. Nick Duran, D-Miami, said for a state that prides itself in being pro-life, “we aren’t positioning ourselves to ensure that women are healthiest they can be when they’re young, all the way through.”
The Affordable Care Act made it optional for states to expand Medicaid. By expanding Medicaid, states cover adults who earn as much as 138% of federal poverty level, or about $29,000 for a family of three.
But in states like Florida, those limits are set much lower.
Medicaid, a public health insurance for low-income people jointly funded by federal and state dollars, covers children, pregnant women, parents, seniors and people with disabilities. About 4 million people in Florida have Medicaid. The majority are children. Adults with no children, including women of childbearing age, no matter how low their income, are not eligible for Florida Medicaid.
Lawmakers in Florida have opposed Medicaid expansion for several reasons. Some have a strong political opposition to the Affordable Care Act, while others worry that the federal government could pull back from paying for most of the cost of the Medicaid expansion, leaving the states to figure out how to pay for it.
In Florida, once women become pregnant, they can qualify for Medicaid as long as their income is at or below 196% of the federal poverty level. That’s about a $42,000 annual income. That coverage expires at the end of the second month after the baby is delivered.
But studies have shown that health and mental care for moms should continue far beyond the early days after delivery, when complications such as high blood pressure or depression can affect moms and as a result, the babies’ care.
“It’s becoming increasingly clear that we can’t just cover women while they’re pregnant,” said Joan Alker, executive director of Georgetown University Center for Children and Families. “Expanding Medicaid is not enough to address the many challenges our country faces with respect to the health of mothers and babies. But without it, and without the continuous affordable comprehensive coverage for women of childbearing age it provides, it will be near impossible to see sharp improvements.”
Florida’s uninsured rate has dropped by 10% since the Affordable Care Act went into effect in 2014, from 29% in to 19%. But according to the study, there are twice as many uninsured women in Florida between ages 18 and 44 compared with states that have expanded Medicaid. The rate of uninsured Florida women in that age range is 19%, compared to the average of 9% in states that have expanded Medicaid.
The state’s rate of maternal deaths has fluctuated over the years without a drastic change, from 17.8 deaths per 100,000 births in 1999 to 16.5 deaths in 2017, according to the state health department data. That’s 35 deaths in 1999 compared to 37 deaths in 2017. Black women in Florida are more than twice as likely to die within the first year of giving birth than white women.
In California, which has the nation’s lowest maternal mortality rate, about 5 in 100,000 women die during the first year after delivery.
Infant mortality rates in Florida have seen a somewhat of steady but small decline during the past two decades, dropping from 8.2% in 1999, or 1,443 deaths, to 7.8% in 2017, or 1,355 deaths, according to the Florida Department of Health. Again, black babies are more than twice as likely to die within the first year of birth than white babies.
Massachusetts has the nation’s lowest infant mortality rate at 3.7 in 100,000 babies.
Discussions about Medicaid expansion didn’t go far in the most recent legislative session. Instead, the Florida House passed a bill for Medicaid work requirement, which could have led about to 100,000 low-income parents to lose their health insurance, Alker said. The bill did not get much traction in the Senate.
Duran, who introduced a bill during the most recent legislative session to expand Medicaid for certain individuals, said “the report is just a great indicator of how easy the decision should be about us moving forward with Medicaid expansion.”
“I’m an eternal optimist,” said Duran. “And I will always look at the next session as the opportunity to expand the conversation on Medicaid program.”