Across the country pregnancy-related maternal mortality has been on the rise in recent years.
In Utah, 40 women died of pregnancy-related deaths in 2015 and 2016, according to the state’s most recent data. Most of those deaths occurred in the month or so after birth.
But one of the best ways Utah and other states can slow this increase is by expanding coverage of Medicaid health insurance for pregnant women, according to new research released Wednesday.
That’s a politically controversial issue in Utah, though, where coverage gaps remain following the limited expansion state lawmakers passed in February. Meanwhile, the national problem of maternal mortality has gotten worse, said Adam Searing, who led the research at Georgetown University’s Center for Children and Families.
“The United States has one of the highest rates of maternal mortality in the industrialized world. And while other wealthy countries have gotten better, we have gotten worse,” said Searing, also a professor at Georgetown University.
Even states that have fully expanded Medicaid under the Obama-era Affordable Care Act could do better at addressing America’s maternal mortality rate by expanding coverage for pregnant women, Searing said. With increased attention being paid to America’s pregnancy-related death rate, that may be starting to change.
Federal legislation and laws in at least three states have been proposed to lengthen Medicaid coverage for women up to one year after pregnancy. But that’s not the case in Utah, where women who earn more than 100% of the federal poverty level — $21,330 for a family of three — are at risk of losing their insurance 60 days after giving birth.
Lawmakers hope to be able to offer deeply subsidized health insurance on the Affordable Care Act marketplace in the coming year but are first awaiting approval from the federal government.
Hannah Wankier found herself in a similarly vulnerable position in January 2018, but unlike some, she made it through the worst of her pregnancy complications.
Like thousands of other uninsured and expecting mothers, money was tight for Wankier when she was was pregnant with her first child.
Then 23, Wankier was about to lose her college health insurance after graduating from Brigham Young University. Her husband, who works on a ranch, was also uninsured.
Still, everything seemed to be going fine — until week 28.
That’s when, during a routine checkup, doctors noticed her blood pressure was high, and diagnosed her with preeclampsia, a dangerous and sometimes fatal pregnancy-related condition. She was immediately hospitalized.
But Wankier automatically qualified for the state’s Medicaid program for pregnant women, and with the help of a social worker, signed up on the spot. It proved prescient. Over the next five days her blood pressure remained dangerously high until doctors performed an emergency C-section.
Born 11 weeks early, her daughter Violet weighed just 1 pound, 15 ounces. She stayed in the neonatal intensive care unit for 64 days before going home.
“I had so much anxiety over bringing home this little girl who was on oxygen,” Wankier said. “I wasn’t sleeping at all. I was terrified of her losing weight because she’d been fed through a tube until about a week before she went home.”
Around the same time Wankier brought her daughter home — two months after giving birth — her temporary Medicaid insurance ended. The problem was her health issues didn’t.
While she got medication to control her blood pressure, the stress of caring for her new daughter sent Wankier into postpartum depression. She says she got angry and frustrated. She’d leave the baby with her husband, get in the car and drive.
Wankier had few options to treat her mental health without insurance.
“You feel like ‘Oh, I’m going to [be] more of a burden by seeking out therapy. Maybe I just need to power through this,’” she said. “I was pretty much alone through the hardest part of it.”
These days her husband has a new job as an electrician and they have insurance through his work. But in Utah, which has the highest birth-rate in the country, there are many other women who are still at risk of not getting the coverage they may need. And it often comes down to cost concerns.
“We discover that they stop taking the medication or they didn’t follow up on certain medical treatments because of financial reasons,” said Jewel Maeda, the Perinatal Mortality Review Coordinator with the Utah Department of Health.
Maeda leads a group that reviews infant and maternal deaths to find out what happened and to try to prevent similar fatalities in the future.
“Medicaid really needs to continue through one year postpartum,” Maeda said. “Because that’s when the majority of deaths actually happen.”