President Biden on Tuesday signed into law an act that creates a $15 million program to support maternal care at the Department of Veterans Affairs and study what maternal health issues veterans are facing.
The act is the first piece of legislation from the “Momnibus” — a wide-ranging package created by the Black Maternal Health Caucus to address the country’s crisis of pregnancy-related deaths that disproportionately affects Black people — to pass through Congress and be signed into law.
“The whole thing is about saving moms’ lives,” Rep. Lauren Underwood, one of the bill’s sponsors who has led the legislative effort, told The 19th. Underwood, an Illinois Democrat, was in attendance at Tuesday’s bill signing. In the Senate, where it passed unanimously, it was authored by Sens. Tammy Duckworth, an Illinois Democrat and combat veteran, and Susan Collins, a Maine Republican.
Roughly 3 in 5 pregnancy-related deaths in the United States are preventable, per the Centers for Disease Control and Prevention, and Black and American Indian or Alaska Native people are about three times as likely to die from a pregnancy-related cause as a White person.
Pregnancy-related deaths in the United States have been steadily on the rise since 1987, when the CDC began reporting the data. The maternal mortality risk for Black women has been 3 to 4 times higher for the last six decades, the Health and Human Services Department found in a 2010 report.
The disparities are deeper than income: Researchers have pointed to systemic racism in birth-related care as a root cause.
Preliminary Veterans Affairs data, from a project started in September to study the impact of pre-pregnancy health risks on maternal outcomes among women veterans, suggests that pregnancy-related deaths among veterans using the agency’s maternity care benefits are nearly double the national rate.
Women veterans also have a higher rate of chronic mental and medical health conditions — and nearly half of women veterans from 18 to 45 years old are not White, the study’s lead researcher, Deirdre Quinn, wrote in her report. Those demographics are an especially important reason to study what risk factors vulnerable women veterans are facing, she wrote.
Federal legislation to address maternal health disparities is sorely needed, Underwood said — especially since she has not seen adequate legislation in her lifetime. Inequalities fueling maternal morbidity and maternal mortality intersect with many areas, said Underwood, a registered nurse — racial health disparities and segregation, income disparities, education disparities and lack of access to health insurance.
Usha Ranji, associate director of women’s health policy at the Kaiser Family Foundation who has worked in that policy space for nearly two decades, said the Momnibus is different from other legislation because it addresses maternal health on many fronts — not just the immediate crisis of pregnancy-related deaths.
“I don’t know that I’ve seen a package quite like this, specifically focused on maternity care,” she said.
Proposed Momnibus measures, which are also included in the Build Back Better plan that passed through the House earlier this month, would approve $295 million to diversify the country’s perinatal workforce — including $50 million for doulas — and provide $175 million to address housing, food and transportation barriers facing pregnant and postpartum people, as well as environmental risks. The fates of those measures, and the Build Back Better plan overall, are now in the hands of the Senate.
Several bills in the Momnibus package recommend Medicaid changes, like automatic enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) for eligible birthing people after pregnancy and improved telehealth services in maternal health care given through the program.
The Build Back Better plan itself would require states to extend existing Medicaid postpartum coverage — which lasts for 60 days — to 12 months. The American Rescue Plan, which Biden signed into law in March, gave states the option to make that extension.
Expanding Medicaid access is important to improving Black maternal health because Medicaid covers two-thirds of births of Black people, said Erika Geiss, a Michigan state senator who has introduced legislation within her state that aims to support Black people through doula care. Medicaid also pays for nearly half of all births in the U.S.
Within maternal care access, Geiss still worries about pregnant people and new parents who are not income-eligible for Medicaid, but still don’t have enough income to access quality care through other types of insurance.
Parts of the package have stronger bipartisan support in Congress. Three bills in the Momnibus package were co-sponsored by Republicans in either the House or Senate, Underwood told The 19th — the bill focused on veteran care that Biden will sign on Tuesday; a bill to fund maternal mental health programs; and the Tech to Save Moms Act, which would push for telehealth expansion in Medicaid services and fund training and internet access for maternity care providers for areas in need.
“I think that we’re actually in a moment of extreme progress and momentum,” Underwood said. Tuesday’s signing is an especially important moment, she said, as veteran moms can find themselves at a potentially higher risk of maternal death through their service.
The VA wrote in an April blog post that 30 percent of all women veterans receiving health care at the agency are Black — and that since women are the fastest-growing group of VA health care users, the agency expects more Black women to use maternity care benefits at the agency.
“The United States leads the globe in maternal mortality. I mean, every other industrialized nation does better at saving moms’ lives than we do. It’s unacceptable, period,” Underwood said.
In addition to legislation like the Momnibus, Ranji said health care providers can make changes to their own policies to address racism directly — and core issues like discrimination “that have been there for a long time.”
Within health care, institutions and doctors need to address racial inequalities in their practice “so that we aren’t repeating the same mistakes that have gotten us to this place where Black patients, or Black women, are not listened to,” Geiss said.