Analysis of Federal Bills to Strengthen Maternal Health Care

In the United States, approximately 700 women die each year as a result of pregnancy or delivery complications. An additional 50,000 women each year face short or long-term severe consequences to their health as an outcome of pregnancy or labor. Both maternal mortality and severe morbidity have been steadily increasing over the past years, prompting a federal response to maternal health issues. There has been growing attention to wide racial and ethnic disparities in maternal health outcomes as well as gaps in maternity care services in many communities, particularly rural areas.  There has also been growing emphasis on improving care in the postpartum period, such as recommendations to expand care beyond the traditional one postpartum visit.

Medicaid pays for more than four in ten births nationally and is the focus of some of the pending bills in Congress as well as some state efforts to improve maternity care. Federal law requires that all states extend Medicaid eligibility to pregnant women with incomes up to 138% of the federal poverty level ($29,435 annually for a family of three).  Pregnancy-related coverage for the woman must last through 60 days postpartum. In the states that have expanded eligibility for Medicaid under the Affordable Care Act (ACA), many low-income women can remain on Medicaid after the 60 days postpartum period or qualify for federal subsidies to purchase coverage through ACA Marketplace plans. However, in the states that have not adopted the ACA’s Medicaid expansion, postpartum women need to requalify for Medicaid as parents to stay on the program, but eligibility levels for parents are much lower than for pregnant women. As a result, many women in non-expansion states become uninsured after pregnancy-related coverage ends 60 days postpartum because, even though they are poor, their income is still too high to qualify for Medicaid as parents.

The 115^th Congress passed the Preventing Maternal Deaths Act of 2018 (H.R. 1318), which authorized the CDC to increase support for state and tribal maternal mortality review committees (MMRCs). A number of other bills, focusing on maternal health, have been introduced in the Congress in the 2019-2020 session. These pending bills address a number of related maternity care issues, including extending Medicaid postpartum coverage from 60 days to one year, funding for clinical training on health equity and implicit bias, developing broader networks of maternity care providers in rural areas, and research on the potential benefits of Medicaid coverage for doula care. Below, are summaries of several bills on maternal health currently pending in Congress.