How Democrats can use reconciliation bill to reduce infant/maternal mortality in anti-choice states

How Democrats can use reconciliation bill to reduce infant/maternal mortality in anti-choice states

August 3, 2022 0 By Ellen Novack

It’s still not clear what will be included in the final version of the Inflation Reduction Act, or even if it can clear that last hurdle in the Senate. But Democrats can’t go into the midterms without passing the Inflation Reduction Act. Just doing nothing is not going to help elect a new Congress in which the Democrats hold on to the House and increase their Senate majority by at least two seats to make obstructionists Sen. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona irrelevant. 

Right now, Democrats have been scrambling to respond to the Supreme Court’s pro-forced birth stance as a result of Dobbs v. Jackson Women’s Health Organization. Adopting measures to reduce maternal and infant mortality would not only save lives, but also spotlight the hypocrisy of the Republican faux-Christian forced birthers—who call themselves “pro-life” but do not really value the lives of mothers or infants.

The $1.75 trillion Build Back Better Act passed by the House last November included $165 billion in health care spending. Among its provisions were measures to permanently fund the Children’s Health Insurance Program, which covers 10 million children from low- and middle-income households.

That bill, the cornerstone of President Joe Biden’s domestic policy agenda, went nowhere in the Senate thanks to total Republican opposition as well as Democratic Sens. Manchin and Sinema, who wouldn’t provide the votes to pass the bill through the reconciliation process, which only requires a simple majority rather than the 60 votes needed to break a filibuster.

The House bill provided coverage to an estimated 2.2 million low-income, uninsured Americans, many of them people of color, in the 12 states that chose to opt-out of the Affordable Care Act’s expanded Medicaid coverage. The opt-out option was part of the 2012 Supreme Court decision that upheld the ACA’s constitutionality. Wisconsin, South Dakota, Wyoming, Kansas, South Carolina, Texas, Tennessee, North Carolina, Mississippi, Alabama, Georgia, and Florida were the states that opted out.

As a result of the Dobbs decision, abortions have either already been banned or will imminently be banned in eight of the states. Abortions are likely to be banned in Georgia. In three states—Florida, North Carolina, and Kansas—abortions are legal for now, but that could change.

The House-passed bill also would have required states to extend Medicaid postpartum coverage to a full 12 months after birth, rather than the current minimum of 60 days. That’s important because Medicaid covers nearly half of all births in the U.S.

The Kaiser Family Foundation (KFF), a non-profit organization that tracks health statistics, published a detailed report on maternal health-care provisions in the House-passed BBBA. KFF summarized its findings as follows:

Increasing attention has centered on postpartum care, including recovery from childbirth, follow up on health complications, management of chronic conditions, access to family planning, and mental health care. However, for many birthing parents who live in states that have not expanded Medicaid under the ACA, coverage for this care is elusive and access to services is poor. The Medicaid program covers more than 40% of births nationally, including two-thirds among Black and AIAN people.

The KFF noted that in non-Medicaid expansion states, after the postpartum period, birthing parents lose pregnancy eligibility and must re-qualify as “parents of dependent children” to remain on Medicaid.

However, many do not qualify and lose coverage because Medicaid income eligibility levels for parents are much lower than for pregnant people. Additionally, for many, their incomes are too low to qualify for subsidized private plans through the Affordable Care Act marketplace, which are only available to those with incomes above the poverty level. There were about 632,000 Medicaid births in the 12 non-expansion states in 2019. KFF noted that, in Alabama, a married mother with a newborn is in this coverage gap if she and her partner have an annual income above $3,952 (18% FPL).

Mississippi should be singled out because it imposed the 15-week abortion ban that resulted in the case the Supreme Court’s conservative majority used to overturn Roe v. Wade. Mississippi already has the highest infant mortality rate in the nation, according to the federal Centers for Disease Control and Prevention. It is only likely to get worse if Mississippians are forced to give birth while being denied Medicaid coverage.

But in March, Mississippi House Republican leaders refused to bring a bill to a vote that would have allowed mothers to stay on Medicaid for a year after giving birth. Currently, they are covered for only two months—the minimum allowed under federal law. The legislation had passed the state Senate.

Cassandra Welchlin, executive director of Mississippi Black Women’s Roundtable, sharply criticized the “pro-life” state House GOP leaders for killing the bill. “They quite possibly killed moms who won’t have access to health coverage to address issues that may arise after giving birth,” Welchlin told the Associated Press. About 60% of births in Mississippi in 2020 were financed by Medicaid, according to KFF.

The Center for American Progress, a progressive think tank, issued a report on how the Build Back Better Act would improve health care coverage and lower costs. It mentioned a section of the House-approved bill aimed at improving maternal health care for vulnerable populations, in particular racial and ethnic minority groups. The report said:

The Build Back Better Act also includes provisions from the Black Maternal Health Momnibus Act, a package of 12 bills that aims to address the Black maternal health crisis in the United States by investing in the maternal health care system, addressing maternal social determinants of health, and ensuring pregnant and postpartum people are protected from the effects of COVID-19. Collectively, these changes will not only improve maternal health but also help address the wide racial disparities in maternal mortality: Black and Native American women are around three times more likely to die from pregnancy-related complications than white women.

And that’s another good reason for Democrats to use the Inflation Reduction Act to expand maternal health care: it would help improve the lives of the party’s most loyal and engaged constituent groups.

Of course, reducing the maternal and infant mortality rates does not address the overall impact of the Supreme Court’s decision to roll back abortion rights. But it would save lives and spotlight how little Republicans actually value life when they vote against such legislation.

And in doing so, Democrats could boost their prospects in the upcoming midterms by laying down a marker about what the next Congress could do if the Democrats hold the House and increase their Senate majority.

A new Democratic-controlled Congress could pass a more ambitious reconciliation act as proposed by President Biden that would provide paid family leave, restore the expanded child tax credit, universal and free pre-school, child care assistance, and other measures to expand the social safety net for families.

And we could have a Senate that would end the filibuster, allowing for the passage of legislation that would codify Roe v. Wade to guarantee abortion rights nationwide. And then guarantee marital equality, protect voting rights, and expand the Supreme Court.