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When it comes to reproductive care, Mississippi has a double distinction. The state spawned the law that will likely lead to the Supreme Court’s overturning of Roe v. Wade. It is also unique among Deep South states for doing the least to provide health care coverage to low-income people who have given birth.
Mississippi residents on Medicaid, the government’s health insurance program for the poor, lose coverage just 60 days after giving birth. This is often long before the onset of postpartum depression or life-threatening infections related to childbirth: study 2020 found that people accrued 81% of their postpartum expenses between 60 days and a year after giving birth. And Mississippi’s own Maternal Mortality Review Committee found that 37% of pregnancy-related deaths between 2013 and 2016 occurred more than six weeks after delivery.
All other states in the Deep South has extended or is in the process of extending Medicaid coverage to 12 months postpartum. Wyoming and South Dakota are the only other states where trigger laws will ban nearly all abortions if Roe falls and lawmakers haven’t expanded Medicaid or expanded postpartum coverage.
“It’s hypocrisy to say that we’re pro-life on the one hand, that we want to protect the baby, but yet you don’t want to pass this kind of legislation that will protect this mom who has to take responsibility for this child,” said Cassandra Welchlin, executive director of the MS Black Women’s Roundtable, a nonprofit that works at the intersection of race, gender, and economic justice.
Efforts to extend coverage beyond 60 days have failed several times in Mississippi — where 60% of births are covered by Medicaid — despite Support major medical associations and legislators on on both sides of aisle.
Mississippi House Speaker Philip Gunn, a Republican, said shortly after killing the last bill that would have expanded postpartum coverage that he was against expansion any form of Medicaid. “We have to look for ways to keep people away, not put them in,” he told The Associated Press in March. Asked about the issue during a May 8 interview on CNN, Mississippi Governor Tate Reeves mentioned, “When you talk about these young girls, the best thing we can do for them is to provide and improve their educational opportunities.” (Neither Gunn nor Reeves responded to requests for comment.)
During the pandemic, a change in federal rules prevented states from cutting off Medicaid beneficiaries, allowing people in Mississippi and elsewhere to retain postpartum coverage beyond 60 days. But at the end of the federal declaration of a public health emergency – which is due to expire in July 2022 — States will revert to their previous policies. “What we’re afraid of is that when this ends, it will go back to what we knew was pre-pandemic health care,” Welchlin said.
We discussed the implications of Mississippi’s post-Roe reality with Welchlin and two other experts in the field: Alina Salganicoff, Kaiser Family Foundation director for women’s health policy, and Andrea Miller, president of the National Institute for Reproductive Health. Their responses have been lightly edited for length and clarity.
What services does Medicaid provide after childbirth?
Salganicoff: Typically everything from assistance if the person has breastfeeding problems to screening services for depression.
Welchlin: We know the struggles of so many people who have had life-threatening illnesses such as heart problems and high blood pressure. Of course, we know that Medicaid contributes to this.
What have you seen in terms of postpartum needs in Mississippi?
Welchlin: One of the stories that really touched me during this pandemic is that of a mother who already had a child and needed access to daycare so she could come and go to the doctor. During this particular pregnancy, she had a severe heart condition where she could not breathe and she had to be rushed to hospital. Because she was so connected to doulas and a supportive care organization like ours, she was able to get admitted and of course that’s when they diagnosed her with this heart condition. And she was a mom on Medicaid.
What happens when mothers lose their Medicaid coverage after childbirth?
Miller: Only giving someone two months after giving birth doesn’t provide the kind of ongoing care you need. If there are signs of problems in the postpartum period, they do not necessarily all appear within the first two months. And we certainly know that the ability to have a healthy baby and keep a healthy baby is also related to whether you have coverage. The 12-month extension really allows for that kind of continuum of care.
Welchlin: We know that in the state of Mississippi, women are dying at higher rates, and of course it’s higher for black women. And so when women don’t have that coverage, what happens is they die.
What does it mean to not extend postpartum Medicaid coverage if Roe falls?
Miller: These abortion bans will add to an already unconscionable maternal and child health crisis that particularly affects those struggling to make ends meet. This particularly affects black women and other communities of color. … A state like Mississippi that so clearly wants to ban abortions – the fact that it refuses to expand basic health care benefits that will help during pregnancy and postpartum clearly indicates that it is not interested not to the health and welfare of women and families and children, that they are purely on an ideological crusade.
Anything else you wanted to add?
Salganicoff: We are very focused on this first year of life. But if you’re talking about a woman who won’t be able to have an abortion and ends up carrying the pregnancy, the supports she and her child will need go far beyond the first year of life.
Miller: You cannot have a conversation about the legality or future illegality of abortion in these states and not have a conversation simultaneously about the current crisis around maternal and child health. These things are all interconnected, and that’s why it’s so deeply troubling that the states trying to ban abortion are the same states refusing to expand Medicaid under the ACA, not taking advantage of the possibility of extending postpartum [coverage] at 12 months, not investing in child care, not investing in education—it’s all part of the same conversation.
Welchlin:Audre Lorde said, “There is no single-issue wrestling because we don’t live single-issue lives.” So access to abortion, reproductive justice, suffrage, racial justice, gender equity – these are not separate issues, they are intersecting issues that collectively determine the quality of our lives.