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Uninsurance rate goes up, activists address maternal mortality

Nearly 2 million more people were uninsured in 2018, Census reports

For the first time in 10 years, the number of people without health insurance increased significantly last year, according to a report released by the U.S. Census Bureau this week. The nationwide percentage of people who were uninsured grew from 7.9 percent in 2017 to 8.5 percent in 2018, as nearly two million more people had no health coverage.

The news marked a reversal of steady progress that had been made since the enactment of the Affordable Care Act (ACA) in covering more and more people.  The Trump administration has worked to undermine and sabotage the ACA – first through a failed attempt at Congressional repeal and then through a series of regulatory and administrative actions. Last year was the first year in which there was no tax penalty for going uninsured, since it was removed through the Trump tax legislation.

One of the biggest increases in number of uninsured people came among low-income people who rely on Medicaid coverage, which the Trump administration has been attacking in various ways, including allowing states to impose work requirements on Medicaid enrollees. Also alarming was an increase of 425,000 in the number of uninsured children, largely due to declines in Medicaid or Children’s Health Insurance Program (CHIP) coverage. Middle-class families who earn too much to qualify for premium subsidies in the ACA marketplaces also lost coverage as rising premiums deterred enrollment. Young adults – ages 19 to 25 – had the highest percentage of un-insurance (14.3 percent, up from 13.7 percent in 2017.

States with the largest increases in numbers of uninsured people from 2017 to 2018 included Alabama, Arizona, Idaho, Ohio, Michigan, Tennessee, Texas and Washington State. Texas continued to have the nation’s highest un-insured rate at 17.7 percent. Three states did make progress in increasing the number of insured people, despite the hostile federal policies – New York, South Carolina and Wyoming.

“Even as the poverty rate falls, more Americans are uninsured, including more children, workers, and higher-income people,” wrote Katie Keith, in an analysis in Health Affairs. “Many of these trends have likely been impacted by the various policy changes or positions adopted by the Trump administration. These policies range from the ‘public charge’ rule to the approval of Medicaid work requirements (and other changes to the Medicaid program) to ongoing efforts to undermine the ACA.” She noted that there were significant increases in un-insurance among Hispanics and undocumented people.

Keith predicted that “coverage losses are expected to continue in 2019,  explaining that his is due to a number of factors, including repeal of the individual mandate penalty, the expanded availability of non-ACA plans, and the final ‘public charge’ rule.”

The Census report is likely to provide new fodder for Democratic Presidential candidates, several of whom are campaigning for Medicare for All health insurance programs. Ten of those candidates will debate tonight in Houston, TX.

Black Women’s Health Imperative speaks out about
Maternal Mortality Crisis

Maternal mortality and morbidity is a growing health crisis in the United States, impacting women of color at three times the rate of their white counterparts. Every year approximately 700 women die of childbirth related complications and many more are severely injured. The Black Women’s Health Imperative (“BWHI”) is invested in the overall wellness of Black women and the families that they care for and is taking action to address the crisis in Black maternal health.

Linda Goler Blount (pictured above), BWHI’s CEO, was a guest panelist at the Maternal & Infant Health Summit hosted by DC Mayor Muriel Bowser on Tuesday. She discussed the impact on Black women’s health of the extreme levels of stress in the work environment.  Goler explained that Black women work on average about 20% longer hours in the private sector than their white counterparts.  She believes that there’s no real benefit to their employers, but “there is a toll on that Black women’s health. If senior bonuses were tied to the wellness of employees, we would see a different workplace and better health outcomes for Black women,” stated Goler.  BWHI believes that maternal mortality will have to be addressed by looking at larger forces that undermine Black women’s health, as well as improving care for pregnant women.

During the Congressional Black Caucus meetings in Washington, DC this week, the Black Women’s Health Imperative will be presenting their research and analysis on maternal health at an issue forum sponsored by Congresswoman Lauren Underwood titled, “Healthy Mother, Healthy Communities: Opportunities and Challenges to Ending Health Disparities for Black Women.”

Maternal Health is Important Before, During, and After Childbirth

This week, the health subcommittee of the House Energy and Commerce Committee held a hearing on four pending bills related designed to improve maternal health policy. These legislative initiatives allocate resources to ensure mothers receive the necessary support before, during, and after childbirth.  The following bills: H.R. 1897 - Mothers and Offspring Mortality and Morbidity Awareness Act and H.R. 2902 - Maternal Care Access and Reducing Emergencies ActH.R. 1551 - Quality Care for Moms and Babies Act and H.R. 2602- Healthy MOMMIES Act.

The Committee heard testimony from Wanda Irving, the mother of Dr. Shalon Irving (pictured below), who passed away in 2017 due to a pregnancy-related complication that occurred after she had been released from the hospital (postpartum). Shalon’s mother described how her daughter’s concerns about her symptoms were dismissed by doctors. “You [referring to Dr. Irving] just had a baby…it takes time to get used to it…you’ll be fine” is what many healthcare providers said.  Shalon Irving died 21 days after giving birth.

Other witnesses touched on related issues, including the importance of Medicaid coverage. Dr. David Nelson, an ObGyn from Parkland Hospital in Texas, talked about the importance of Medicaid coverage especially for prenatal and postpartum care. His message was reinforced by Usha Ranji, Associate Director of Women’s Health Policy at Kaiser Family Foundation, who told the Committee that federal action to extend post-partum Medication coverage beyond 60 days  is essential to prevent women from being uninsured when they are still vulnerable to pregnancy-related death. In a rare show of bipartisanship, members from both sides of the aisle were actively engaged, asking questions, and discussing related topics such as mental health, racism, substance abuse and how they impact maternal health outcomes.

Several bills addressing maternal mortality have been introduced in both the House of Representatives and the Senate, but none are likely to move forward unless public pressure intensifies. This hearing and the information shared by the witnesses are just one important step towards policy changes that will help save lives.  For more information about how our regional coordinators are working on this issue, read our earlier newsletter on Black maternal mortality.

Afiya Center Launches Southern Roots Doula Collective!

For the past five years, The Afiya Center, our Dallas-based regional coordinator, has made a commitment to addressing Black maternal mortality in the state of Texas. Through their work, they have forced the state government to begin studying the crisis, pressed the legislature to adopt new programs to address high death rate, and begun training doulas, lay health care workers who remain with the person giving birth throughout the entire process. Last week, The Afiya Center officially launched its Southern Roots Doula Collective.

In her introduction of the Collective, Marsha Jones, Executive Director, recalled an email she received in April 2014 from the Black Women’s Roundtable explaining that the maternal mortality rate for Black women is fully three times that of white women and is on par with developing nations.

“That day I resolved that we,The Afiya Center, would work to end reproductive annihilation of Black women by Texas lawmakers legislating the removal of our reproductive freedoms. We know that saving us will require us taking control of us! Black midwives and doulas have a long and incredible history in contributing to successful birthing outcomes of Black mamas and Black babies, assuring that Black mamas and families were able to make healthy birthing decisions, to have the births of their choice, and experience this in an environment of trust maintaining their dignity” said Marsha. Thus far, the Collective has participated in three births and last week celebrated their first home birth! For more information on Southern Roots Doula Services, click here.

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