Moms, babies make big gains under Medicaid expansion

By Sharon L. Carte

Jun 4, 2019

After a long public health career frequently reading and learning of poor health statistics or rankings for West Virginia, nothing cheers me like learning we are on top for a change, and it should cheer you, too.

Yes, West Virginia is among the top three states (along with New Mexico and Kentucky) with the highest declines in the rate of uninsured women of child-bearing age (18 to 44 years), according to a recent report by Georgetown University’s Center for Children and Families. This good news means most women of child-bearing age in our state now have increased access to preventive care during pregnancy, their chances for adverse health outcomes are reduced and maternal mortality can be reduced.

This is a clear effect of coverage gains for women of child-bearing ages in states where Medicaid expanded under the Affordable Care Act, and it has led to amazing results for moms and babies.

The CCF report states, “women are getting better health care coverage before pregnancy, leading to improved prenatal nutrition and prenatal care. And postpartum coverage has improved for women, helping them get the care they need following the birth of their child.”

A key reason why: In the states with expanded Medicaid, the chances that women of child-bearing age experience the frequent on-again and off-again coverage breaks and disruptions over short time periods (known as “churn”) is decreased. Churn is much more common among women in lower income ranges.

Now it is clear: Better continuous coverage means better health for moms and their babies. The uninsured rate for women of child-bearing age is nearly twice that in states that did not expand Medicaid under the ACA as it is in those that did (16 percent versus 9 percent). For states with expanded Medicaid, infant mortality rates saw a 50 percent greater reduction than it did in states that did not expand. In states that did not expand Medicaid, many of which have higher minority populations, there is an opportunity to decrease strong racial disparities which, if tackled, could help decrease our national maternal mortality overall.

We also get a “two-for-one” effect in areas such as maternal mental health screening and tobacco cessation, which can boost the health of moms and babies. For states like ours, challenged with opioid use and other substance use disorders, the chance to treat and restore a mom to parenting is perhaps the greatest boon of all.

Even with this positive movement, there is still the challenge of next steps. There is the not-so-good news of how maternal mortality in the United States lags behind that of other developed nations. A sudden loss of coverage after 60 days past their delivery is a time when women may still encounter serious health care issues. This is another churn that can undo much of what was positive before delivery.

Another piece of good news is this study was based on data through 2017. In this year’s legislative session, West Virginia has now increased Medicaid to cover more uninsured pregnant women, so we can see even more women and babies benefit.

Only a very small percentage of women in our state should be faced with not having health care coverage upon learning they are pregnant and will need prenatal care.

These dramatic gains mean it is time to assure continuous health care coverage for moms well after a birth. No child needs to lose mothering and nurturing in its critical first year to postpartum depression. We do not need to funnel more children into foster care because substance use treatment stopped when a mother lost coverage.

Building on the outstanding improvement effects seen in this report surely make this a worthwhile goal.