Texas, red states consider expanding Medicaid after abortion restrictions

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Since abortion restrictions were implemented in Texas, the organization has seen homeless women with unintended pregnancies seek shelter. (Video: Whitney Shefte/Washington Post)


Makayla Robinson is seven months pregnant, unemployed, lives in a maternity hospital in Dallas, and is dependent on medical care from Medicaid, which may end next spring.

In Texas, Medicaid only covers new mothers for two months after giving birth. For now, Robinson, 22, and others have up to a year of coverage due to the federal pandemic public health emergency that President Biden extended through April.

Robinson worried about what would happen next.

“I won’t be able to go to the doctor,” she said. “…I’m having financial problems. Medicaid has really helped.”

The limits on Robinson’s Medicaid coverage after emergency insurance expires rest on Texas’ longstanding denial of Obamacare, including expanded Medicaid provisions. And that set up an uncomfortable dynamic: Texas and nearly a dozen other red states are resisting expanding Medicaid for pregnant women, but many of them also restrict access to abortion. and more new mothers need compensation.

Now, Republican legislators in Texas, Mississippi, Wyoming, and other red states are either committed to further restricting abortion or join anti-abortion groups and Democratic lobbying efforts to increase postpartum Medicaid coverage. You are faced with the choice of whether to expand the

“There is a debate between Republicans and anti-selectives about what to do to support mothers.” Usha Ranji, Associate Director of Reproductive Health Policy at Kaiser Family Foundation, said:

Several national anti-abortion groups that support the expansion of postnatal Medicaid have said that after the Supreme Court’s Dobbs ruling revoked abortion protections, new state restrictions on abortion meant that pregnant Proposed another law to expand human funding. Law vs. Wade.

Steve Aden, general counsel and chief legal officer of Washington-based Americans United for Life, said: “I think the whole movement is looking for ways to implement policies at the state level to support more women having children.”

Republicans have long controlled both houses of the Texas legislature, and last year they were able to pass one of the toughest abortion laws in the country, ahead of a Supreme Court decision. Last year, the House of Texas also passed a bill that would expand postpartum Medicaid for one year. was halved in half a year. Abbott signed the bill, but the Biden administration refused to extend it because it didn’t cover people who had abortions.

Right to Life and other anti-abortion groups in Texas are now lobbying for a one-year postpartum Medicaid extension in the next legislative session beginning in January.

“This policy fits into the larger collage of pro-life policies we can pass to promote a pro-life Texas,” said John Seago, president of Texas Right to Life. “We want Texas to be an abortion-free state, but we also want Texas to be pro-life. We want these mothers to be healthy and getting the care they need. I would like to be able to receive it.”

The conservative Texas Public Policy Foundation, based in Austin, also supports expanded postnatal Medicaid, arguing it could save the state money through preventative care.

“With so many complications, there’s the cost of going back to states with so many uninsured people. It’s much better to make sure these mothers are healthy so they can take care of their children.” is.” Said David Balat, director of the Foundation’s Right on Healthcare initiative and former hospital executive, said:

Robinson was homeless when she arrived. Shortly after moving from Memphis to Dallas, the nonprofit Viola’s House Maternity Hospital didn’t realize that the Tennessee legislature had agreed to extend postpartum Medicaid for up to a year starting this spring. She says she escaped the “toxic environment” of violence in her neighborhood, left her partner behind and sought a better quality of life in Texas, naming her son Uriah. I decided to.

Robinson graduated from high school, but had not graduated from college. He first worked as a housekeeper in a hotel, but he had to quit soon and he couldn’t stand all day. She applied for front desk and restaurant positions, but she said, “Most jobs don’t want to hire me when they see her belly sticking out.”

Viola’s House serves, provides housing, coordinates medical care, and provides other support to five homeless pregnant women aged 18 to 24 at a time. Most people are already enrolled in Medicaid, according to Yolanda Washington, a residential services manager who helps arrange health care.

She said increased Medicaid coverage during the pandemic has helped residents bounce back.

“It makes a difference. It takes that long for a woman to get six weeks off, breastfeed her baby, get up and get insurance from work,” Washington said.

She said many of the women in maternity hospitals don’t know their Medicaid benefits are about to expire. I was told it doesn’t apply.

Without Medicaid coverage, Washington said: Or birth control? ’ The only way they go is the emergency room. ”

Viola’s House founder and executive director Thana Hickman-Simmons said she tries to stay out of politics because she gets funding from both sides of the abortion issue as well as from the state. But she was troubled to see many pandemic benefits end. There is also the possibility of postpartum Medicaid.

“Can governments do more for mothers facing unplanned pregnancies? Absolutely. said Hickman Simmons. “All services needed to sustain life must be funded.”

Seago’s lobbying for postpartum coverage — “Don’t call it an expansion of Medicaid, just guarantee insurance for mothers up to the first year of life” — has gained support in the Texas House of Representatives, including includes Republican House Speaker Dade Phelan, who helped pass the bill last year. And still committed, the staff said.

But for the law to pass In the next session, Phelan must convince fiscal conservatives in the Texas Senate. Some, including far-right Lieutenant Dan Patrick, said the measure would save money in the long run and should be a priority. Anti-abortion proposals by Hughes and others, such as banning out-of-state travel for abortions and requiring men to pay child support after conception.

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

“The real question is when do we pay for this care? Is it preventative or after we give birth and go to the emergency department? It’s a morally wise investment,” Shego said.

The state’s other large anti-abortion group, the Texas Alliance for Life, had not taken a position on expanding postnatal Medicaid, but said its board was still considering measures. spokesperson Amy O’Donnell said.

Shego is Push for a revised version of last year’s bill sponsored by Rep. Toni Rose.

“She’s a pro-abortion Democrat, but this is an area where pro-life supporters support her and this agenda,” he said.

Rose said it makes sense for anti-abortion groups to support the measure.

“This is a bill that saves lives. We want to save lives,” she said. “…as I said to my colleague, if you’re pro-life, you should be able to stand by this.”

Rose said Texas Senate leaders need to consider the ramifications of the abortion stance.

The American College of Obstetricians and Gynecologists endorsed postpartum Medicaid extensions, stating in a statement that while maternal mortality rates are rising nationwide, “the growing evidence suggests that many of these deaths are due to overdose, in particular. indicate that it was due to a preventable cause, such as malaria or suicide, and occurred after pregnancy – the associated Medicaid coverage ends.”

Pregnant Texans are more likely than other states to have no insurance, are less likely to seek antenatal care, and have higher maternal mortality and morbidity rates, especially among black women.State Health Services At least 52 pregnancy-related deaths were reported in 2019, 27% of which occurred between 43 days and 1 year after conception, according to a report released this month by the agency. Serious medical complications from pregnancy and childbirth also increased significantly from 2018 to 2020, from 58.2 to 72.7 per 10,000 live births in Texas, according to the report.

One of the committee’s top recommendations is to extend postnatal health insurance coverage to one year.

“People are rapidly moving away from pregnancy-related coverage and getting no coverage. Income eligibility standards are very low in Texas, private coverage is not available, emergency rooms are being addressed or not addressed. “They’re not reporting any serious health concerns,” said Kari White, principal investigator of the Texas Policy Evaluation Project at the University of Texas at Austin.

Without expanded coverage, “pregnant Texans would fall through a gaping hole in the safety net,” she said.

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