Mississippi Just Killed a Bill That Would Have Combated Maternal Mortality

On March 9, the Mississippi House of Representatives killed a bill that would have allowed mothers to keep Medicaid coverage for a year after giving birth; currently, mothers can keep the coverage for two months. Senate Bill 2033 passed the Senate on February 2 and the House Medicaid Committee on March 1, but House Speaker Philip Gunn (R) and House Medicaid Committee Chairman Joey Hood (R) did not bring it up to vote as the March 9 deadline passed to consider general bills in the House.

Gunn was publicly against Medicaid expansion. While he stated he was aware of Mississippi’s high maternal mortality rate, he had not seen evidence that extending postpartum coverage would be cost effective. He also said that “we need to look for ways to keep people off [Medicaid], not put them on.”

Maternal health care continues to be a critical issue in the United States. The country’s maternal mortality rate is high compared to other developed nations and, according to the Centers for Disease Control and Prevention (CDC), has risen in recent years.

Mississippi is among the states with the highest maternal death rates. The Mississippi State Department of Health released a report in 2019 assessing the maternal mortality of the state between 2013 and 2016 and found that in those years, Mississippi had almost twice the ratio of pregnancy-related mortality compared to other states, with Black and Indigenous individuals up to five times more likely than White individuals to die due to pregnancy-related issues.

The report also noted that cardiovascular conditions and hypertensive disorders of pregnancy were the most frequent causes of pregnancy-related death in the state and that, despite the misconception that active labor is the riskiest part of pregnancy, 86% of maternal deaths happen postpartum, with 37% of those deaths occurring six weeks or more after giving birth.

In light of the findings, the report recommended that state leaders extend postpartum Medicaid coverage from 60 days to one year after giving birth; another study indicates that Medicaid expansion is associated with lower maternal mortality rates compared to non-expansion states.

Medicaid provides health care coverage for low-income people and, in many cases, is the only option for individuals to receive pregnancy-related services, including prenatal care, childbirth, and postpartum care. According to the Kaiser Family Foundation, in 2020, approximately 60% of births in Mississippi were financed by Medicaid, ranking much higher than the national average of 42%. Only Louisiana, at 61%, had a higher rate.

Mississippi is one of the dozen states that have not expanded Medicaid to working people whose jobs do not provide health insurance under the Affordable Care Act (ACA). Additionally, according to the U.S. Census, Mississippi is the poorest state in the country, with more than 18% of the population living below the poverty line and an average per capita income of $24,369. This leaves many low-income parents who do not qualify for Medicaid or subsidies in the marketplace without health care coverage. Full Medicaid expansion would narrow the coverage gap in these states and improve access to postpartum care for low-income mothers.

According to the Kaiser Family Foundation, 26 states have introduced laws to extend postpartum Medicaid coverage for a year after delivering.

Expanding Medicaid postpartum coverage would be a significant step in improving maternal health in Mississippi and reducing maternal mortality rates across the United States. For a long time, the postpartum period has been arbitrarily defined as six weeks following birth, although the dangers to women continue well beyond that time period. Cardiac events, hypertensive crises, and blood clots from pregnancy can remain past the six-week postpartum period.