JACKSON, Miss. — In 2019, then-Gov. Phil Bryant proclaimed that he wanted Mississippi to be “the safest place for an unborn child in America.”
In Bryant’s view, that meant signing some of the strictest abortion laws in the country. One of them, the state’s 15-week abortion ban, is now before the U.S. Supreme Court, with national implications for abortion rights.
The same year Bryant made the declaration, a group of physicians in Mississippi released recommendations aimed at preventing maternal and infant deaths in a state with the highest infant mortality rate in the country.
One change that the state’s Maternal Mortality Review Committee advocated in 2019 was to allow women to keep their Medicaid health insurance coverage for a year after they give birth, rather than being cut off after 60 days, which is the current policy. The group of physicians found that almost 40 percent of pregnancy-related deaths in the state occurred more than six weeks after women gave birth.
Dr. Charlene Collier, an OB-GYN practicing in Mississippi’s capital and co-chair of the Maternal Mortality Review Committee, is still waiting for that potentially lifesaving measure to be adopted.
“In Mississippi, there’s been a lot of focus on the issues of abortion and restricting that, but there’s no commensurate efforts to improve birth outcomes for pregnant women and babies in the state,” she said.
Many of the mothers insured by Mississippi’s Medicaid program are among the state’s poorest residents and cannot afford medical care after the 60-day cutoff. The resulting decisions they make to delay or forgo needed treatment can come at the expense of their lives. Almost two-thirds of pregnancy-related deaths are preventable, according to the U.S. Centers for Disease Control and Prevention.
Mississippi is one of 12 states that have not expanded Medicaid access under the Affordable Care Act, which would offer another pathway for women in poverty to gain health insurance coverage. Among Southern states that have also not expanded Medicaid, at least three — Georgia, Texas and South Carolina — have extended, or sought to lengthen, health insurance coverage for new mothers for at least six months.
But in Mississippi, efforts to offer women a full year of postpartum Medicaid coverage have failed. A proposal to do so last year was scrapped as legislators argued over a separate issue: how much control the governor’s office should have over the state Medicaid agency, according to the Mississippi Free Press.
Republican and Democratic lawmakers are trying again this legislative session and have filed bills in the Senate and the House to expand benefits. Both chambers will face a deadline of Feb. 1 to bring the proposal up for a committee vote.
A bill filed by state Senate Medicaid Committee Chairman Kevin Blackwell, a Republican, would make permanent a temporary extension of Medicaid for postpartum women that went into effect in 2020 as part of the federally declared coronavirus emergency. The legislation has the backing of Lt. Gov. Delbert Hosemann.
“Access to healthcare during and after pregnancy is crucial, protecting the lives of mothers and their children,” Hosemann, a Republican, said in a statement.
But the legislation could face a tougher challenge in the House, where Republican leaders have been more vocal about other priorities. They have focused on teacher pay raises and eliminating Mississippi’s income tax as top goals. Gov. Tate Reeves, a Republican, made no mention of a Medicaid expansion in his 18-page budget recommendation.
A spokesperson for Reeves did not respond to a request for comment. A spokesperson for Speaker of the House Philip Gunn did not comment, and House Medicaid Committee Chairman Joey Hood did not respond to a message seeking comment.
Robert Johnson, chairman of the House Democratic Caucus, said he suspects some representatives have shied away from publicly supporting the measure because of the thorny debate surrounding a broader Medicaid expansion, which would provide coverage to the working poor. Gunn and Reeves are on record in opposition.
“Sadly enough, everyone ought to just jump on board,” Johnson said, “but there’s a whole apprehension about it being a lead into Medicaid expansion.”
Yet he said he feels more confident about the chances of advancing conversations on the proposal this year, given bipartisan support some Republican initiatives, such as tax cuts and teacher pay raises, have won early in the session.
The impact of the bill’s passage would be far-reaching. In 2017, almost 70 percent of pregnancies in Mississippi were covered by Medicaid.
Statewide, policy experts and physicians say, the consequences of inaction are unforgiving: children growing up without their moms and communities scarred by the loss of their youngest members.
The state has the highest infant mortality rate in the country, with about 9 deaths per 1,000 births in 2019, and a higher than average maternal mortality rate, with 33 deaths per 100,000 births from 2013 to 2016. During the same period, maternal mortality rates for Black women in Mississippi were nearly three times as high as those of white women.
“It’s obvious to the Legislature, these statistics are not new,” Collier said. “It’s just the will to act upon them.”
Dr. Edith Smith Rayford has seen that the need for specialized care some of her patients receive in pregnancy does not dissipate at two months after they give birth.
As an OB-GYN at a federally qualified health center in Jackson, she cares for patients who fall into the post-60-day coverage gap. Pregnancy is often the first time women have reliable access to health care as adults, Collier and other doctors said. Some learn they have diabetes or high blood pressure, which can pose risks for women and their babies during pregnancy as well as after birth.
“It’s tough, especially when people have chronic health problems,” Smith Rayford said.
Her office is in a hallway featuring a bulletin board covered in pictures of newborns the center has helped welcome. The images often elicit smiles.
But she said there’s a dread that can set in as patients approach their 60-day cutoff and their providers scramble to find them a Plan B in the country’s poorest state, which has weak health care support for its most vulnerable people.
Pregnant women who sought treatment through Medicaid for health problems that might otherwise have gone untreated have few options for continuing to receive medical care after they’ve given birth. For the patient who started seeing a cardiologist during pregnancy, now there’s the question of who will take them on without insurance. For the mom who needed expensive medications, there are new out-of-pocket costs that may be impossible to pay.
“Sometimes, I am diagnosing things for the first time in pregnancy,” said Dr. Nina Ragunanthan, an OB-GYN based in the Mississippi Delta.
One of her patients developed preeclampsia in pregnancy and later required close care for severe depression, which the patient was able to receive because of the temporary Medicaid extension under the federal Covid-19 emergency.
“If after 60 days, we didn’t have coverage for those things, there’s no way she could afford medicines and therapy on her own,” Ragunanthan said. “She would have lost access to care. That is detrimental to the moms and their infants who need healthy moms.”
Seven months after giving birth to her daughter, Nye’Keya Smith is able to have counseling sessions and doctor’s visits paid for through the temporary Medicaid extension.
Smith’s daughter Brooklyn arrived early. Smith spent days in the hospital recovering, while Brooklyn was closely monitored in the NICU for almost three months.
“I didn’t know if she would make it,” she said. “I could only hold her for so many hours. I got really discouraged.”
The experience left her shaken, and she sought help for postpartum depression. Last month, she went to a therapy session, one of many since her daughter’s arrival, that she credited with improving her mental health. The job she recently accepted as a certified nursing assistant does not guarantee insurance, and she said she’s thankful that she has a safety net through the temporarily expanded postpartum Medicaid coverage.
“I’m able to just walk in when I need to,” she said.
But it’s not clear how much longer coverage for moms like her will last. And for now, Mississippi doesn’t have an answer for what will happen when it runs out.