With this change, Texas can save the lives of new moms

Women who lose Medicaid health coverage soon after giving birth are at high risk of bad outcomes

By Dallas Morning News Editorial

Childbirth is a joyous time for a mother, but also can lead to medical crises, postpartum depression, and premature death, including suicide.

At a time when new mothers are so vulnerable, access to medical resources and counseling that could save lives should be available. However, if a new mother is poor, several post-childbirth risk factors sharply increase, and a key safety net is available for only the first two months after delivery. Medicaid health insurance currently provides coverage for new mothers for just 60 days despite the fact that medical experts say new mothers are at risk of suffering psychological and medical setbacks related to childbirth for at least a year.

It is heartwarming that womens’ health issues have caught the attention of some lawmakers. With slight differences, SB 141 by Sen. Nathan Johnson, SB 1187 by Sen. Carol Alvarado, HB 107 by Rep. Senfronia Thompson, HB 133 by Rep. Toni Rose, HB 146 by Rep. Shawn Thierry, and HB 98 by Rep. Lina Ortega all extended Medicaid health insurance for new mothers from 60 days to one year after pregnancy.

We urge lawmakers to extend benefits for a year and not put more women at risk. Roughly, 89% of pregnancy-related deaths reviewed since 2013 were preventable and 31% occurred 43 days to one year after the end of pregnancy, according to the state’s Maternal Mortality Review Committee. The committee also determined that Black and Hispanic new mothers were at elevated risks of bad outcomes.

In 2018, for example, the severe maternal morbidity rate for Black women in Texas was 299.4 cases per 10,000 delivery hospitalizations, significantly higher than the overall state rate of 182.3, as were the statistics for Hispanic mothers. The severe maternal morbidity rate includes “unexpected outcomes of labor and delivery that result in significant short-term or long-term consequences to a woman’s health,” according to the Centers for Disease Control and Prevention.

Texas ranks an embarrassing last, at 25.5% in the rate of uninsured women of childbearing age, according to a Georgetown University study, so expanding Medicaid coverage to 12 months would be a step forward. Women who lose health coverage soon after giving birth are likely to stop taking medication or obtain support for postpartum depression and treatable maladies such as infection, hemorrhage, preeclampsia, eclampsia, and cardiovascular and coronary conditions.

Texas lawmakers have known that this is a major problem but have come up short in previous sessions. Two years ago, the state House approved legislation to provide 12 months of Medicaid coverage to mothers following childbirth only to watch that bipartisan bill fail when the state Senate didn’t take action before the deadline to consider legislation.

Texas temporarily paused removing mothers from Medicaid coverage during the COVID-19 emergency, undoubtedly saving lives. Lawmakers must deliver a bill that extends benefits for one year, and the governor should sign it.

This article originally appeared in the Dallas Morning News at https://www.dallasnews.com/opinion/editorials/2021/03/17/with-this-change-texas-can-save-the-lives-of-new-moms/.

Sen. Nathan Johnson: We need to expand Medicaid in Texas now

Public opinion now supports the shift, and there’s federal money to pay for it.

By Nathan Johnson | Dallas News

The conventional political wisdom has been the same for Republicans and Democrats: Don’t say Medicaid expansion. I suppose that explains the nervous chuckling I used to hear when I kept giving the same answer to different questions: How can we help our millions of uninsured citizens? Expand Medicaid. What can we do to stimulate the Texas economy? Expand Medicaid. How do we raise state revenue without raising taxes? Expand Medicaid.

Much has changed in the past few years. Medicaid expansion is now politically popular in Texas, and a time-tested success across the nation. But the political inertia persists, and Texas remains one of only 14 states that haven’t implemented some form of Medicaid expansion.

COVID-19 brings a new urgency to the matter. Medicaid expansion would not only provide care to those most in need but would also help us combat the contagion and provide powerful economic stimulus when we need it more than ever.

It’s time for Gov. Greg Abbott to use his executive authority to expand Medicaid in Texas, now.

Consider the need even before COVID-19. Among the 50 states, Texas has the highest number and percentage of uninsured citizens. Some 1.5 million of the uninsured fall into the expansion gap, earning too much to qualify for Medicaid but too little to qualify for federal insurance subsidies. Their lack of access to health care harms all of us, by increasing the burden of uncompensated care, driving up health care costs, overcrowding emergency rooms, and lowering the state GDP. On the fiscal side, starting next year Texas stands to lose billions of (our own) federal tax dollars when our current non-expansion deal expires and new federal regulations drastically undercut the patchwork system we use to pay for indigent health care.

In contrast, numerous studies have shown that expansion states have seen improved health, increased use of primary care, decreased use of emergency care, lower smoking rates, higher employment rates, improved family financial stability and sustained operation of rural hospitals. On the fiscal side, economist Ray Perryman estimates that expansion would bring about $8 billion into the Texas economy annually, increase gross state product by $29.4 billion over just the first two years, generate a 331% return on investment over 10 years, and have a net positive effect on the state budget.

The COVID-19 crisis has magnified both the needs and the benefits associated with expansion. Workers in the service sector have lost their jobs and as a result lost their insurance. Many among our essential workforce — front-line health care workers, grocery store clerks, drivers and many others — have never been able to afford health coverage in the first place. We should all take pride in providing them with access to care. Meanwhile, social restrictions aimed at protecting life and preserving hospital capacity show the need to accelerate deployment of telemedicine services, and to be able to track, treat, quarantine and isolate. Medicaid expansion serves these ends.

As the 37th state to expand Medicaid, Texas wouldn’t be venturing into uncharted territory. In fact many Republican-led states have expanded Medicaid. Indiana did under then-Gov. Mike Pence. Ohio, Arizona, Indiana and others were able to use expansion to reform and improve their existing Medicaid programs, adding conservative favorites such as health savings accounts, behavior incentives and changes to delivery systems.

There’s no avoiding the expansion conversation any longer. It can’t be brushed aside by saying, “I’m waiting for a block grant.” The Trump administration just offered block grants. (Many, including me, believe that a block grant isn’t the best vehicle, but it’s still Medicaid expansion.)

And early conservative questions and doubts have been answered and dispelled by the positive results in the 36 other states that expanded Medicaid by standard means. Although differences between states do matter, the federal government has made clear that Texas will enjoy unprecedented flexibility in crafting a plan that accommodates its unique needs.

Supporting expansion now is not flip-flopping; it is altering strategy in response to better information and different circumstances. Today we have overwhelming public and business support, successful conservative models, greater flexibility, an even higher level of need, profound urgency and, as part of the federal COVID-19 crisis response, billions of federal dollars that can be employed to ensure that Medicaid expansion in Texas is a fiscal and health care success.

Only the governor can expand Medicaid immediately. Successful implementation over the long term, however, will require both Republicans and Democrats to recognize that Medicaid expansion is a vital and effective means to address our most urgent economic and health care challenges. And that it’s OK to say it.

Nathan Johnson is a Democrat representing Dallas in the Texas Senate. He wrote this column for The Dallas Morning News.