Extending Medicaid pregnancy coverage could save lives; 'We actually abandon women after delivery,' doctor says

States with extended Medicaid pregnancy coverage, categorized. California's
extension only covers women with mental-health needs, and Missouri's would
would only cover drug-addicted women. (Stateline map; click on it to enlarge)

Medicaid pregnancy coverage pays for nearly half of all births in the U.S., and rural women rely on it more than others. But it expires 60 days after childbirth, leaving many women without health insurance when they're at a higher risk of dying: about 700 American women died from pregnancy-related health issues in 2016. Rural women have a higher risk of poor birth outcomes.

"Nationwide, drug overdoses, suicides and pregnancy-related chronic illnesses such as diabetes, heart disease and high blood pressure are contributing to a rise in deaths among women during pregnancy, childbirth and the first 12 months after delivery," Christine Vestal reports for Stateline. "According to the U.S. Centers for Disease Control and Prevention, three out of five of those deaths could be prevented with adequate medical attention." Women can reapply for Medicaid as a parent after pregnancy coverage lapses, but the income limit is usually much lower, so many women don't qualify.

Some state and federal policymakers are trying to lengthen Medicaid pregnancy coverage. A bipartisan bill in Congress would give states incentives to extend such coverage to a full year after delivery by cutting red tape and increasing federal funding by 5 percent, Vestal reports. Lawmakers in at least six states (California, Illinois, Missouri, New Jersey, South Carolina and Tennessee) are considering extending Medicaid pregnancy coverage to a full year after delivery, and health agencies in Georgia, Texas, Utah and Washington and recommending similar changes.

Maternal mortality rates, which include deaths during and up to a year after pregnancy, are higher in the United States than in other developed nations. "And while pregnancy-related death rates have been dropping worldwide, they’ve more than doubled in the United States in the past 30 years, rising from 7 deaths per 100,000 live births in 1987 to 17 in 2016, according to the CDC," Vestal reports. "The opioid crisis is a contributing factor. Opioid addiction among pregnant women has quadrupled in the past 20 years, the CDC said."

Women with substance abuse disorders generally do well during pregnancy if they have access to social services and health care, but "Where things fall apart is postpartum," said Mishka Terplan, an obstetrician-gynecologist affiliated with the University of California at San Francisco. "We actually abandon women after delivery."