Illinois will be the first state to expand health insurance access for people who have just given birth, a step experts have said will be critical in addressing the nation’s pregnancy-related death crisis.
The change, announced by the U.S. Department of Health and Human Services Monday, will extend Medicaid coverage for low-income pregnant and postpartum people in Illinois to a full year after giving birth. Previously, people who qualified for the health insurance plan — which insures about half of all births nationally — would lose their health insurance after 60 days postpartum. The state estimates that this change will affect about 2,500 people per year.
Reproductive health experts have been pushing for states to take this step. The United States has twice the pregnancy-related death rate of other wealthy nations, and Black and Native American women are two to three times more likely than White, Latina and Asian-American women to die within a year of childbirth, per the Centers for Disease Control and Prevention.
About a third of pregnancy-related deaths occur between 45 days and a year postpartum. Most of those deaths are considered preventable if people can access appropriate, competent medical care, addressing both the physical and mental health complications that often accompany birth. A vast body of research suggests that expanding access to insurance would help achieve that.
The change is also expected to particularly benefit Black pregnant people, who — thanks to underlying systemic inequities — are more likely to be insured through Medicaid.
“That’s an evidence-based solution that will help end this disparity and save moms’ lives,” U.S. Rep. Lauren Underwood, an Illinois Democrat, told reporters.
Illinois’ change came through federal approval of a Medicaid 1115 waiver, an application to the federal government to change how the state runs its health program. States are then asked to monitor the results as a sort of large-scale scientific experiment.
But the pathway to extend postpartum Medicaid has just become easier — the American Rescue Plan Act, President Joe Biden’s first major piece of legislation, which passed in March, included a provision to allow states to extend postpartum Medicaid coverage. The federal government said Monday it expects other states to follow suit.
“There’s been a lot of interest in this,” HHS Secretary Xavier Becerra said. “We want states to join in, we want other states to come on board.”
That could have appeal in both blue and red states, unlike the Affordable Care Act’s optional provisions to expand Medicaid’s reach, which have often been vulnerable to the hyper-partisan politics surrounding the health law. In Texas, the state’s House Speaker has endorsed a bill to opt into the Medicaid extension. Florida state leaders have also expressed interest in doing so. Still, it’s not universal. Mississippi, for example, recently declined to extend postpartum Medicaid. In that state, 22 out of every 100,000 births result in the new parent’s death — the 21st highest pregnancy-related death rate in the country.
Health insurance is only one part of the issue. In Illinois, for instance, people who recently immigrated often do not know if they qualify for Medicaid, advocates recently told The 19th — a challenge that they say stems from years of anti-immigrant rhetoric by former President Donald Trump, as well as an effort to penalize immigrants who use public health insurance when they apply for green cards. That never took effect, but it deterred people from using programs like Medicaid, experts have found.
When someone is pregnant and eligible for Medicaid, they can retroactively get coverage, which pays for prenatal care and delivery. But by the time people find out, it may be too late to reverse chronic conditions that have worsened, and that can ultimately lead to complications when or after someone gives birth.
And, researchers note, access to insurance will not address other factors that have fueled the pregnancy-related mortality crisis. The disparity between Black people and White people exists regardless of income, studies have shown. Experts suggest that implicit bias and institutional racism also play a role in driving up the nation’s death rate.
“Just because you have access to health insurance, doesn’t mean you have access to care, or that the care you have access to is beneficial or good to you,” Katy Kozhimannil, an associate professor at the University of Minnesota School of Public Health, recently told The 19th.