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I’ve been working to expand access to affordable health coverage for children and families for more than two decades. After the birth of my daughter, I heard with different ears the story of my own birth – the nurses sent my dad home “to rest” and left my mother laboring overnight without checking on her because they didn’t want “to disturb the doctor on Sunday.”
I realize now how my or my mother’s life could have ended in tragedy. When a family member of mine recently experienced a stillbirth, I knew well that the health care system might have contributed to her personal heartbreak and how far we need to go to address maternal and child health outcomes. And as a mother, I am reminded that my risk of dying in childbirth is more than three times the risk for a woman with the same education, income level and insurance – just because I’m a Black woman.
What I’ve experienced personally is a symptom of our country’s devastating racial and ethnic disparities in maternal health outcomes. The United States has the worst maternal mortality rate among industrialized countries. American Indian/Alaska Native and Black women are two to three times more likely to die from a pregnancy-related cause than white women. And two out of three pregnancy-related deaths in this country are preventable.
Tackling maternal mortality crisis
On Tuesday, under the leadership of Vice President Kamala Harris, the White House is convening a nationwide Maternal Health Day of Action. The vice president, White House domestic policy adviser Susan Rice and Health and Human Services Secretary Xavier Becerra have a longstanding commitment to addressing maternal health disparities. We are using all the tools at our disposal to effect change.
As a mother and as the first Black woman to lead the Centers for Medicare & Medicaid Services, my mission is to give all parents the greatest gift I can – the support they need to care for and protect their children. CMS is a $1 trillion federal agency that provides health coverage for more than 144 million people and more than 40% of the nation’s childbirths, and we are taking important steps to tackle the maternal mortality crisis.
We plan to establish a new “Birthing-Friendly” hospital designation that would be posted on our CMS “Care Compare” website to help people identify hospitals that have implemented evidence-based quality initiatives to particularly keep pregnant and postpartum patients safe.
I am also proud to be partnering with states to encourage them to extend Medicaid coverage for postpartum people when they need it most. Through the American Rescue Plan, states now have an easier pathway to extend postpartum coverage for a full year after childbirth. Without this coverage extension, pregnant people risk losing Medicaid coverage as early as 60 days postpartum, even though the need for comprehensive care can extend well beyond those early weeks.
The new easier pathway that we outline Tuesday takes effect in April, but many states can’t wait to help families. CMS recently announced that Virginia, New Jersey and Illinois extended health coverage and access to crucial care for 12 months postpartum for people with Medicaid coverage. We encourage all states to follow the lead set by Virginia, New Jersey and Illinois to support families in the vulnerable postpartum period.
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Now is our time to fundamentally change our health care system and reach those people the system has failed. On the whole, ingrained racism in our health care system means we do not care equitably for people who are Black, Latinx, American Indian and Alaska Native, and other people of color. This inequity leaves millions of people unable to access the care they need. That’s why the president is urging the Senate to pass the Build Back Better Act, which has already passed the House and advances equity through a historic $3 billion investment in maternal health and requires states to expand postpartum coverage through Medicaid for a full year after birth.
Making it easier to stay covered
Expanding Medicaid coverage in the 12 states that have not yet adopted the Affordable Care Act’s Medicaid expansion, as well as guaranteeing coverage for people for a full year after giving birth, can also help lead to better health outcomes, according to an analysis from the Department of Health and Human Services.
The House-passed Build Back Better Act would deliver health care coverage to up to 4 million uninsured people in states that have locked them out of Medicaid. Due to systemic inequities, people of color and people in rural areas are more likely to qualify for Medicaid. Investing in the Medicaid program means reaching those most at risk – including the 1 in 5 women of reproductive age covered by the program.
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Across CMS, we are also improving access to and quality of maternity care. We’re making it easier to enroll in and keep Medicaid coverage. We’re also partnering with states to expand coverage of childbirth supports, such as doulas, that have been shown to improve birth outcomes. And we’re expanding our provider quality measurement programs. We can also learn from other nations with more advanced maternal health support than America has. For example, when I was living in Australia for my husband’s job soon after my daughter was born, I experienced firsthand how postpartum nurse-led classes, new mom support groups and convenient health care access can make such a difference in the life of a new mom and her baby.
I look forward to working collaboratively with hospitals, health systems and state partners to embrace evidence-based best practices and to embed them into the fabric of how we deliver affordable, comprehensive care. Together we can improve maternal health, advance health equity and, ultimately, save lives.
Chiquita Brooks-LaSure is the administrator for the Centers for Medicare & Medicaid Services. Follow her on Twitter: @BrooksLaSureCMS