Texas, red states consider expanding Medicaid after abortion restrictions

Since abortion restrictions were imposed in Texas, the group has seen a growing number of homeless women with unwanted pregnancies seeking shelter. (Video: Whitney Shefte/The Washington Post)


Makayla Robinson is seven months pregnant, unemployed, and living in a Dallas maternity hospital where her Medicaid-based health care may end next spring.

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

Robinson worries about what happens next.

“I couldn’t go to the doctor,” she said. “…I had financial problems. Medicaid really helped.”

The limits of Robinson’s Medicaid coverage after the emergency insurance lapsed depended on Texas’ longstanding rejection of Obamacare, which included provisions to expand Medicaid. It has created an uncomfortable dynamic: While Texas and nearly a dozen other red states have resisted expanding Medicaid for pregnant women, many of those states have also restricted abortion, leading more new mothers to need insurance.

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

“Republicans and those who are against choice are talking about what should we do 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 additional legislation to expand funding for pregnant women as states impose new restrictions on abortion after the Supreme Court’s Dobbs ruling removed protections for pregnant women. Roe v Wade.

β€œOn our side, after Roe moved to women, people realized and took very strong steps,” said Steve Aden, general counsel and chief legal officer of Washington-based Americans United for Life. ) Say. “I think the whole movement is looking at ways to implement policies at the state level to support the growing number of women who want to have children.”

Republicans have long controlled both chambers of the Texas legislature, allowing them to pass one of the strictest abortion laws in the country ahead of a Supreme Court decision last year. Last year, the Texas House of Representatives also passed a measure that would expand Medicaid for one year after childbirth. But the Texas Senate — including senators. Bryan Hughes, author of the state’s restrictive abortion law, cut Medicaid in half to six months after childbirth. Abbott signed the bill, but the Biden administration rejected an extension because it did not cover those who had abortions.

Now Texas Right to Life and other anti-abortion groups are lobbying to pass a one-year postpartum Medicaid extension in the next legislative session, starting in January.

“This policy fits into a larger collage of anti-abortion policies that we can pass to advance anti-abortion in Texas,” said John Seego, president of Right to Live Texas. “We want Texas to be abortion-free, but we also want Texas to be pro-choice. We want these mothers to be healthy and have access to the care they need.”

The conservative Austin-based Texas Public Policy Foundation also supports expanding the postpartum Medicaid program, arguing it could save the state money through preventive care.

“A lot of uninsured countries are paying the price with many complications. It’s better to make sure these mothers are healthy so they can take care of their children,” Say David Balat, director of the foundation’s Right on Healthcare initiative and former hospital director.

Robinson was homeless when he arrived Not long after moving from Memphis to Dallas, the nonprofit Viola’s House Maternity Home didn’t realize Tennessee lawmakers had just agreed to extend postpartum Medicaid for a year starting this spring. She said she fled a “toxic environment” of community violence, leaving her partner in Texas to find a better quality of life for her son, whom she plans to name Yuria.

Robinson, who graduated high school but not college, started out as a hotel housekeeper but soon had to quit because she couldn’t stand all day. She applied for front-of-house and restaurant positions, but, she said, “most jobs didn’t want to hire me because I had a protruding belly.”

Viola’s House provides housing, coordinates medical care and other support to five homeless pregnant women between the ages of 18 and 24 at a time. Most arrive already enrolled in Medicaid, according to Yolanda Washington, a residential services manager who helps them arrange health care.

Expanding Medicaid coverage during the pandemic has helped residents get back on their feet, she said.

“It’s important. It takes this long for a woman to take six weeks off, breastfeed her baby, start getting out of bed and get insurance from her job,” Washington said.

Many women at the maternity home don’t know their Medicaid benefits will expire, she said. Three years ago, her granddaughter found out it was a difficult process when she went to the doctor and was told she no longer had insurance.

Without Medicaid coverage, Washington said, “it prevents them from going to preventive care because they say, ‘How do I pay for a Pap smear? Or birth control? Their only way out is the emergency room.'”

Thana Hickman-Simmons, founder and executive director of Viola’s House, said it gets funding from the state government as well as from both sides of the abortion issue, so she’s trying to stay out of politics. But she is disturbed to see the end of many pandemic benefits, possibly postpartum Medicaid.

“Could the government do more for mothers facing unwanted pregnancies? Absolutely. They’re making the rules, but they’re not doing enough for the rules they’re making,” Hickman-Simmons said. “You have to fund all the services that are needed to sustain life.”

Seago’s lobbying for postpartum insurance — “Don’t call it Medicaid expansion, just make sure moms get coverage for a year after birth” — won support in the Texas House of Representatives, including Republican House Speaker Dade Phelan, He helped pass the measure last year and remains committed, the staff said.

but let the law pass In the upcoming session, Phelan will have to convince fiscal conservatives in the Texas Senate, Including the right wing lieutenant.Governor Dan Patrick, the measure saves money in the long run and should be a priority Other anti-abortion proposals proposed by Hughes and others, such as banning out-of-state travel for abortions or requiring men to pay child support from conception.

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

“It’s really a question of, when are you paying for this care: preventative or after she gives birth and ends up in the emergency room? From our perspective, it’s a smart investment, both financially Or morally,” Seago said.

The state’s other large anti-abortion group, the Texas Alliance for Life, has yet to take a stand on expanding the postpartum Medicaid program, but its board is still considering the measure, spokeswoman Amy O’Donnell said. Donnell) said.

Sego is Push for a revised version of last year’s bill sponsored by the House of Representatives. Tony Ross.

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

Ross said it made sense for anti-abortion groups to support the measure.

“This is a pro-life bill. We want to save lives,” she said. “…As I say to my colleagues, if you support abortion, you should be able to support this.”

Ross said Senate leaders in Texas must consider the consequences of their attitudes toward abortion: “If we want women to have children, let’s give them the resources they need to do so.”

The American College of Obstetricians and Gynecologists backs the extension of the postpartum Medicaid program, noting in a statement that while maternal mortality rates are rising nationwide, “there is growing evidence that many of these deaths, especially due to drug overdose and Preventable causes like suicide, it all happens after pregnancy β€” when Medicaid ends.”

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

Among the committee’s key recommendations: Extending postpartum health care coverage to one year.

“People are rapidly dropping out of pregnancy-related insurance and not getting coverage because the income eligibility threshold in Texas is very low, and they’re not getting private insurance and reporting health issues they’ve had or haven’t had in the emergency room,” Deutsche said. Kari White, lead researcher at the Texas Policy Evaluation Project at the University of Texas at Austin, said.

Without expanded coverage, she said, “pregnant Texans are literally going to fall through the holes in the safety net.”

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