Medicaid covers nearly half of annual births in the U.S. Under the status quo, that coverage ends 60 days postpartum. As a temporary measure during Covid-19, women who would usually lose Medicaid eligibility now remain covered up to one-year postpartum — in many states, however, that change is not here to stay.
It should be.
A significant percentage of maternal deaths occur outside the coverage period.
In the U.S., a staggering 20% of maternal deaths happen between 43 days and one-year postpartum, the time that mothers on Medicaid are being dropped from coverage, with disproportionately higher rates among black women. In the states that have not implemented the Medicaid expansion, maternal death rates are higher.
These statistics alone should be enough to make the argument for pregnancy Medicaid expansion, and they are merely the tip of the iceberg.
Mothers on Medicaid are more likely to suffer from mental health issues postpartum.
While close to one in every seven pregnant/postpartum women experience mood and anxiety disorders, the rates for low income individuals — who are more likely to be on Medicaid — are even higher, ranging from 40-60%.
These rates stem from a multitude of factors, many related to social determinants of health. Women on Medicaid are more likely to struggle with substance abuse, intimate partner violence, and smoking addiction, among other things, and research has shown that these factors have a direct affect on mental health in the postpartum period.
Research has also shown that deaths and long term complications from maternal mental health issues can and do occur any time within the first year postpartum, and extended insurance coverage provides an essential safety net for women struggling with these disorders.
Children become collateral damage of dropped coverage.
Depressed mothers who lack care or adequate support often experience a reduced capacity to raise, care for, and create a bond with their infant. This can have devastating effects on the child’s well being—physically, emotionally, and behaviorally—beyond infancy and into childhood. Studies have shown connections between postpartum depression in the mother and outcomes like reduced communication abilities, mood disorders, and delayed cognitive development.
The ROI of Medicaid expansion is significant.
Bracketing the very real human impact of dropping coverage, Medicaid expansion makes sense from a purely financial perspective. Mental health disorders lead to increased reliance on public programs for support, decreased engagement at work, and are extremely costly to the U.S healthcare system: postpartum depression and anxiety disorders, left untreated, cost the United States over $14 billion in 2017 alone.
This doesn’t even begin to touch on the incalculable downstream economic and societal costs of children who have been raised without mothers, or by mothers lacking access to adequate support services in the year following childbirth.
A commitment to health equity demands Medicaid expansion.
Low-income and minority women are disproportionately likely to both experience postpartum disorders and rely on Medicaid for care. Extending pregnancy Medicaid coverage is a critical step in bridging racial and socioeconomic healthcare gaps, and ensuring that we are truly making good on the promise of health and wellbeing for all — not just for some. If the U.S. is serious about addressing the structural and systemic barriers to equitable care, they need to start here.
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