I have been working for more than two decades to expand access to affordable health coverage for children and families. After the birth of my daughter I heard the story of my own birth with different ears – the nurses sent my father home “to rest” and let my mother work at night without checking her because they “didn’t want to disturb the doctor ” on Sunday.”
I now realize how my or my mother’s life could have ended in tragedy. When a relative of mine recently experienced a stillbirth, I knew full well that the health care system could 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 must remind myself that my risk of dying in childbirth is more than three times the risk for a woman of the same education, income level, and insurance – just because I am a black woman.
What I have personally experienced is a symptom of the devastating racial and ethnic disparities in maternal health outcomes in our country. The United States has the highest 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 in three pregnancy-related deaths in this country are preventable.
Tackling the maternal mortality crisis
Under Vice President Kamala Harris, the White House will hold a nationwide Maternal Health Day of Action on Tuesday. The Vice President, Susan Rice, White House domestic policy adviser, and Secretary of Health and Human Services Xavier Becerra have long been committed to addressing maternal health inequalities. We use all the tools at our disposal to effect change.
As a mother and 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 medical coverage for more than 144 million people and more than 40% of the nation’s births, and we are taking significant steps to address the maternal mortality crisis.
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We plan to introduce a new ‘birth-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 keep pregnant and postpartum patients in particular safe.
I’m also proud to work with states to encourage them to expand Medicaid coverage for postpartum people when they need it most. With the US bailout, states now have an easier way to extend postpartum coverage to an entire year after delivery. Without this extension of coverage, pregnant people are at risk of losing Medicaid coverage as early as 60 days after delivery, even though the need for comprehensive care can extend well beyond those early weeks.
The new, easier path we map out Tuesday will go into effect in April, but many states can’t wait to help families. CMS recently announced that Virginia, New Jersey and Illinois have expanded health coverage and access to critical care for 12 months postpartum for those with Medicaid coverage. We encourage all states to follow the example of Virginia, New Jersey and Illinois to support families in the vulnerable postpartum period.
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Now is the time to fundamentally change our health care system and reach the people the system has failed to reach. In general, racism ingrained in our health care system means we don’t care equally about people who are black, Hispanic, Native American and Alaska Native, and other people of color. This inequality prevents millions of people from accessing the care they need. That’s why the president is urging the Senate to pass the Build Back Better Act, which the House has already passed and boosts equity through a historic $3 billion investment in maternal health and requires states to increase postpartum coverage. extend 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 passed the Medicaid extension to the Affordable Care Act, as well as guaranteeing coverage for people for a full year after delivery, may also help lead to better health outcomes, according to an analysis from the Division of Health and Human Services.
The House-approved Build Back Better Act would provide health care coverage to up to 4 million uninsured people in states that have excluded them from Medicaid. Because of systemic inequalities, people of color and those 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 childbearing age covered by the program.
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Within CMS we also improve access to and quality of maternity care. We’re making it easier to sign up and maintain Medicaid coverage. We are also working with states to expand coverage of childbirth aids, such as doulas, that have been shown to improve birth outcomes. And we’re expanding our supplier quality measurement programs. We can also learn from other countries with more advanced maternal health support than America. For example, while living in Australia for my husband’s job shortly after the birth of my daughter, I experienced firsthand how postpartum nurse-led classes, new mother support groups and easy access to health care can make such a difference in the lives of a new mother and her baby.
I look forward to working with hospitals, health systems and state partners to embrace evidence-based best practices and embed them into the way we deliver affordable, comprehensive care. Together we can improve maternal health, promote health equity and ultimately save lives.
Chiquita Brooks-LaSure is the administrator of the Centers for Medicare & Medicaid Services. Follow her on Twitter: @BrooksLaSureCMS