BEYOND THE NUMBERS
Rather than send flowers, state policymakers should offer women a Mother’s Day gift with longer-lasting benefits: expanding Medicaid coverage and rejecting policies that take coverage away from people who don’t meet work requirements. They should also reject attempts to weaken private health coverage, such as by promoting skimpy short-term plans that don’t provide essential benefits like maternity care.
Nearly 40 million women get health coverage through Medicaid, millions of them thanks to the Affordable Care Act’s (ACA) Medicaid expansion to more low-income adults. Medicaid offers women essential health care services, including preventive care, family planning, care between pregnancies, and care for chronic physical and behavioral health conditions. Some 2.2 million more women could gain coverage if the states that haven’t yet adopted the Medicaid expansion did so.
Unfortunately, some states are moving in the wrong direction. The Trump Administration is letting states take Medicaid coverage away from people who don’t document that they work or participate in work-related activities for a specified number of hours each month. These policies will harm many women caring for children or other family members; caregiving responsibilities can make it harder to work outside the home and, for those who are working, harder to meet a work-hours threshold every month.
Work requirements will also hurt women with disabilities or serious illnesses, who may not qualify for an exemption or struggle with the bureaucratic hurdles to secure one. And they will harm women who work hard in low-wage jobs with inconsistent hours that might not meet the state’s threshold every month.
In Arkansas, the first state to implement these policies, nearly 1 in 4 beneficiaries subject to them lost coverage in 2018 as a result. (While a federal district court struck down state waivers with work requirements in Arkansas and Kentucky, the Trump Administration is still approving these policies in additional states.)
Women who lose coverage due to these policies risk significant harm. Medicaid expansion raised the share of people with a personal physician, getting check-ups, and getting recommended preventive care (such as cholesterol and cancer screenings), studies find, while lowering the shares delaying care due to cost, skipping medications due to cost, or relying on the emergency room for care. Taking away coverage from people not meeting work requirements or otherwise restricting coverage could reverse a large share of these gains.
Losing access to care would especially harm the nearly half of all women with an ongoing condition requiring regular monitoring, care, or medication. For example, the opioid crisis is increasingly affecting women: over 15,000 women died from opioid overdoses in 2017, more than three times the 2007 figure. Women losing Medicaid coverage likely won’t have access to needed treatment and recovery services.
These policies also create coverage gaps that will likely interfere with post-partum and preconception care, exacerbating existing shortcomings in maternal health care — especially for women of color. The number of pregnancy-related deaths per 100,000 live births jumped from 7.2 in 1987 to 18.0 in 2014, according to the Centers for Disease Control and Prevention. Women of color face large racial and ethnic disparities in pregnancy-related mortality: black women were more than three times likelier to die from pregnancy-related causes than white women between 2011 and 2014.
In addition to rejecting Medicaid restrictions, states should protect their residents from the Trump Administration’s expansion of short-term private health plans. These plans, which the Administration says can last up to a year or longer (versus three months previously), don’t have to cover all of the ACA’s essential health benefits. In fact, they often don’t cover such essential benefits as maternity and mental health care, substance use disorder treatment, and prescription drugs; a Kaiser Family Foundation survey didn’t identify a single short-term plan offering maternity care. Also, short-term plans can deny coverage or charge more to people with pre-existing conditions, typically don’t cover medical services related to a pre-existing condition, and can charge women more than men for the same coverage. Eleven states and the District of Columbia have blocked short-term plans or limited them to three months or less, and others should follow.
Expanding and protecting women’s access to essential health care would be an appropriate way for states to mark Mother’s Day.