New report says states lacking Medicaid expansion lag behind in infant and maternal health

Brandon Paykamian • Jun 9, 2019 at 8:18 PM

A report last month from the Georgetown University Health Policy Institute Center for Children and Families found Tennessee has a higher uninsured rate for women of child-bearing age compared to states with expanded Medicaid.

While the uninsured rate for Tennessean women ages 18 to 44 is more than 12%, compared to less than 9% in many states with expanded Medicaid, many Republican legislators in Tennessee continue to resist Medicaid expansion.

Nearly 65% of Tennesseans support Medicaid expansion, but state lawmakers like Rep. Micah Van Huss, R-Jonesborough, have made their opposition clear time and time again.

“We're not at socialism and never will be. I will continue to vote for the policies that have made Tennessee one of the strongest economies in our nation giving our citizens the opportunity to work for what they have,” Van Huss wrote in an emailed statement to the Johnson City Press Wednesday.

Researchers from Georgetown said Medicaid expansion has “played a key role in reducing rates of maternal death, decreasing infant mortality rates and improving the potential for optimal birth outcomes that can increase the promise for a healthy childhood.”

States with expansion saw a 50 percent greater reduction in infant mortality, and this decline was greatest among African-American infants. In addition, health coverage prior to pregnancy helps address risk factors such as obesity, diabetes and heart disease. After pregnancy, women without coverage often go without necessary medications, including those for postpartum depression.

“Health coverage before, during, and after pregnancy is essential to the health and well-being of both mother and child,” Joan Alker, executive director of the Georgetown University Center for Children and Families, said of the report.

“Medicaid expansion is the single most effective way to help women of childbearing age get continuous health coverage during this critical stage of life.”

According to the Kaiser Foundation, Medicaid provides 75% of all family planning services in this country. When it comes to women’s health care, in particular, Women Matter Co-Chairwoman Ruth Taylor Read said Tennessee legislators “display a complete and utter lack of regard for female lives.”

“I think what’s important to notice first on this issue of expanding Medicaid in Tennessee is the overriding male voices making these health care decisions. For women, comprehensive health care is a cornerstone of their mental and physical well-being. Access to quality comprehensive health care provides mammograms, breast cancer treatments, autoimmune disease care, contraception, maternity care and the list goes on and on,” she said.

Lawmakers have opted to fund the state’s Medicaid program through block grants, or a lump sum payment. In April, the state House of Representatives voted to pass House Bill 1280, which would make Tennessee the only state in the nation to fund its Medicaid program using this method.

Along with Democrat critics in the legislature, Michele Johnson, Tennessee Justice Center executive director, said the block grant bill would likely lead to a cut in federal Medicaid funds following the vote.

While state Sen. Rusty Crowe said he was “one of the very few senators that did vote for Gov. (Bill) Haslam's Insure Tennessee" initiative years ago, it failed in the Commerce Committee. No expansion program has moved forward since then.

Crowe said the report does not delve into other factors he believes contributes to the numbers. He said the block grant approach would allow Tennessee to tackle its problems in a more “Tenncentric” way.

“The report does emphasize the importance of a mother’s health prior to pregnancy; however, a lot of these issues could stem from lifestyle and environmental changes that health care coverage alone might not combat. According to the Tennessee Department of Health’s first Maternal Mortality Report, 78 women in Tennessee died in 2017 while pregnant or within one-year post pregnancy. 33% of these deaths were due to the contribution of substance abuse and 18 percent of these deaths were due to mental health conditions,” he said in an emailed statement. “The MMR Committee also found that violence was a substantial factor in these deaths, which resulted in approximately 14% of these women being victims of homicide.”