Texas, red states consider expanding Medicaid after abortion restrictions

Since abortion restrictions were enacted in Texas, the organization has seen an increase in homeless women with unplanned pregnancies seeking shelter. (Video: Whitney Shefte/The Washington Post)


Makayla Robinson is seven months pregnant, unemployed, living in a maternity home in Dallas and relying on health care from Medicaid that could end next spring.

In Texas, Medicaid only pays new mothers for two months after giving birth. In the meantime, Robinson, 22, and others have about a year to work because of the pandemic public health emergency that President Biden extended in April.

Robinson was worried about what would happen next.

“I wouldn’t be able to go to the doctor,” she said. “ … I have financial problems. Medicaid really helped. “

Restrictions on Robinson’s Medicaid coverage after emergency insurance expires hinge on Texas’ long-standing rejection of Obamacare, which includes provisions for Medicaid expansion. And it’s created a dynamic force: While Texas and nearly a dozen other red states have resisted expanding Medicaid for pregnant women, many of them have also limited access to abortion, resulting in more new mothers needing coverage.

Now Republican lawmakers in Texas, Mississippi, Wyoming and other red states face a choice: Focus exclusively on further restrictions on abortion, or join anti-abortion groups and Democrats lobbying to expand postpartum Medicaid coverage.

“There’s a conversation between Republicans and those who are anti-choice about what should we be doing to support mothers?” said Usha Ranji, associate director of reproductive health policy at the Kaiser Family Foundation.

Some national anti-abortion groups that support postpartum Medicaid expansion have proposed other laws to increase coverage for pregnant women, after new federal abortion restrictions came in after the Supreme Court’s Dobbs decision struck down protections for pregnant women. Roe v. Wade.

“On our side, there is awareness and a strong movement behind Roe’s reversal in women’s care,” said Steve Aden, general counsel and chief legal officer of the US-based Americans United for Life. “I think every organization is looking at ways to use policy at the government level to support the increasing number of women who will have children.”

Republicans have long controlled both chambers of the Texas Legislature, which allowed them to pass tougher abortion laws in the state last year ahead of the Supreme Court’s decision. Last year, the Texas House also passed a measure that would have expanded postpartum Medicaid year-round. But the Texas Senate — including Sen. Bryan Hughes, author of the state abortion ban – cut postpartum Medicaid in half to six months. Abbott signed the bill, but because it did not cover abortions, the Biden administration refused to extend it.

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Now Texas Right to Life and other anti-abortion groups are lobbying to pass year-long postpartum Medicaid in the next legislative session that begins in January.

“This policy is part of a larger collage of pro-life policies that we can pass to promote a pro-life Texas,” said John Seago, president of Texas Right to Life. “We want Texas to be pro-life, but we also want Texas to be pro-life. We want those mothers to be healthy and get the care they need.”

The conservative-based Texas Public Policy Foundation of Austin also supports expanded postpartum Medicaid, saying it would save the state money on preventive care.

“Because of the many problems that arise, there are costs that come back to many governments that do not have insurance. It is better to make sure that those mothers are healthy so that they can take care of the children,” said David Balat, director of the Right on Healthcare initiative and former hospital administrator.

Robinson was homeless when he got to the house nonprofit Viola’s House maternity home shortly after moving to Dallas from Memphis, I didn’t know Tennessee lawmakers had just agreed to extend postpartum Medicaid for up to a year starting this spring. She said she fled the “toxic environment” of local violence, leaving her partner behind to seek a better life in Texas for her son, whom she plans to name Uriah.

Robinson had graduated from high school but not from college, He first worked as a housekeeper in a hotel but soon had to quit, unable to stand all day. He applied for desk and restaurant positions, he said, but, “Many jobs don’t want to hire me, they see my stomach sticking out.”

Viola’s House helps five homeless pregnant women ages 18 to 24 at a time, providing housing, coordinating medical care and providing other support. Most come already enrolled in Medicaid, according to Yolanda Washington, a residential services manager who helps plan health care.

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He said the expansion of Medicaid during the violence helped residents get back on their feet.

“It makes a difference. “It takes that long for a woman to rest for six weeks, breastfeed and have a baby, then wake up and get insurance at work,” said Washington.

He said most of the women in the maternity hospital did not know that their Medicaid benefits would expire. His grandson had a hard time when he went to the doctor three years ago and was told that there was no more help.

Without Medicaid coverage, Washington said, “It’s stopping them from going and getting coverage, because they’re saying, ‘How am I going to pay for a Pap smear? Or birth control?’ The only way they go is the emergency room. “

The founder and executive director of Viola’s House, Thana Hickman-Simmons, said it receives support from the government and from both parties on the issue of abortion, so she tries to stay out of politics. But she was concerned to see many of the pandemic benefits end, most likely postpartum Medicaid.

“Could the government do more for mothers facing unplanned pregnancies? Definitely. They make laws and they don’t do enough of the laws they do,” said Hickman-Simmons. “You have to fund all the services that are necessary to support life.”

Seago’s push for postpartum coverage — “don’t call it Medicaid expansion, just guaranteeing coverage for mothers up to a year after birth” — has garnered support in the Texas House, including Republican House Speaker Sister Phelan, who helped pass the measure last year. . and he is still committed, said the staff.

But to pass the law next session, Phelan should lobby the Texas Senate’s treasurers, including Lt. Gov. Dan Patrick, that this move saves money in the long run and should be prioritized. other anti-abortion proposals by Hughes and others, such as banning travel abroad for abortions or requiring men to pay child support from conception.

Hughes and Patrick did not respond to requests for comment on the proposal.

“Actually the question is when to pay for this care: Prevention or after giving birth and ending up in the emergency department? From our point of view, this is a wise investment, financially and morally,” said Seago.

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The Texas Alliance for Life, the state’s other major anti-abortion group, has not yet moved to expand postpartum Medicaid, but its board is still considering the move, spokeswoman Amy O’Donnell said.

Seago i we are pushing an improved version of last year’s bill sponsored by Rep. Toni Rose.

“He’s a pro-abortion Democrat, but this is a place where pro-lifers support him and this program,” he said.

Rose said it makes sense that anti-abortion groups would support the measure.

“It is a pro-life bill. We want to save people’s lives,” he said. “ … As I said to my colleagues, if you are a health-conscious person you should be able to get away from this.”

Rose said Texas Senate leaders should consider reducing their abortion status: “If we want women to have a baby, let’s give them the resources they need to do that.”

The American College of Obstetricians and Gynecologists supports the extension of postpartum Medicaid, noting in a statement that although maternal deaths are increasing nationwide, “growing evidence shows that many of these deaths, particularly from preventable causes such as alcohol abuse and suicide, occur after pregnancy.” -Related Medicaid coverage ends.”

Pregnant Texans are more likely to be uninsured and less likely to seek prenatal care than those nationwide, and the state has high rates of maternal mortality and morbidity, especially among Black women. At least 52 pregnancy-related deaths were reported in 2019, 27 percent of which occurred 43 days to a year after conception, according to a report released this month by the State Department of Health. Major health problems from pregnancy and childbirth also increased significantly between 2018 and 2020, from 58.2 to 72.7 per 10,000 births in Texas, according to the report.

Among the committee’s top recommendations: Extending postpartum health care to a year.

“People fall into pregnancy-related conditions early and don’t get help because the income eligibility threshold is so low in Texas and they don’t get private help and report health problems that they may or may not talk about in the emergency room,” said Kari White, lead investigator of the Texas Policy Evaluation Project at the University of Texas at -Austin.

Without expanded coverage, he said, “Pregnant Texans will fall through the cracks in the safety net.”


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