Health Care/Joan Retsinas

At Last: Something States Can Do, Easily, to Improve Health

COVID has plunged us into the Age of Impotence. A government that once upon a time spearheaded the Marshall Plan to rebuild Europe cannot muster the know-how to furnish our country with tests, with personal protective gear, with clear guidelines. Unlike other countries, we didn’t “flatten the curve,” but watched cases spike. Now we return to lockdowns, we don masks, and we wait, hoping for the vaccine-ex-machina to stop our statistical rise.

While we wait for a vaccine, however, we can upend some other grim statistics. More American women die in childbirth than in the developed world. We can reduce that number.

Briefly, 17.4 mothers in the United States die before, during, or soon after childbirth, for every 100,000 live births annually (not counting deaths from drug overdoses) (from the Centers for Disease Control and Prevention). In Belgium and Austria, the toll is six deaths per 100,000 live births; in Israel and Switzerland, five deaths; in Sweden, Italy, and Kuwait, four deaths.

The maternal maternity data mirror the racial disparity of COVID data: 37.1 black women die per 100,000 live births, compared to 14.7 white women. Put more starkly, black women account for 40% of the maternal deaths. Newborns show the same racial divide: 11.4 black babies of 1,000 live births die each year, compared to 4.9 deaths for white babies.

The numbers are not surprising. Black Americans fare worse on a slew of health measures.

The promising news: we need not wait for a cure to rescue them. A plausible solution is at hand: Health insurance.

Women covered fully by insurance fare better than those uninsured, or partially insured. Under Obamacare, women whose income is 133% (can be higher) of the federal poverty level are eligible for Medicaid. From the start, we designed Medicaid to cover low-income women.

But once they deliver the baby, their coverage can cease.

States had the option, under Obamacare, of extending Medicaid, keeping that income level high, covering more recipients for longer periods. Indeed, the federal government encouraged states to do so with generous subsidies. Expanded Medicaid coverage was part of the overall strategy to cover the “uninsured.”

Yet, initially many states declined the carrot. Their reasons were ideological: Women need to get jobs, be self-sufficient. We don’t want to do whatever a Democratic President wants us to do. We don’t even want Obamacare. The reasons don’t matter.

Eventually, most states came on board, expanding Medicaid. Today, 13 states hold firm to their ideological “no.” (In 2019 Virginia and Maine expanded Medicaid; in 2020, Utah and Idaho did).

The upshot: those states that expanded Medicaid continue to cover women post-partum; the “just say no” ones reverted to lower income thresholds. For those states, the average income level drops to 43% of poverty. In Texas, the level is 17%; in Alabama, 18%. Women in those states give birth, covered under Medicaid, then lose coverage. With that loss of coverage comes a loss of continuity of care. And in that gap women and babies die.

Researchers have suggested that if states expanded Medicaid to cover women post-partum, we would save as many as two-thirds of those deaths.

We cannot easily redress ingrained racism; we cannot — presto — close the black/white gaps in education, in income, in jobs. But we can give black mothers and their babies a better chance of surviving.

All states must take up the option: extend Medicaid to women post-partum. At least on this front, we will end the Age of Impotence that has defined our struggle with COVID.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, December 1, 2020

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