It was revealed yesterday that the Trump Administration may allow lifetime coverage caps for people covered by Medicaid, an illegal move that would threaten the health and well-being of millions of Americans. But beyond the nation’s capital, states are instead looking at ways to expand Medicaid coverage.
Just today, a children’s advocacy organization in North Carolina released a new report arguing that Medicaid expansion could reduce the state’s fetal and infant mortality rates, bolstering the case for the bipartisan expansion proposal the state is currently considering.
Outside of North Carolina, grassroots movements are underway in Nebraska, Utah, Missouri and Idaho to put Medicaid expansion on state ballots in 2018. And just three weeks ago, Oregon voters supported a legislative tax package funding the state’s Medicaid program. Back in November, Maine voters overwhelmingly approved Medicaid expansion in the state.
“The Trump Administration and Congressional Republicans are doing the exact opposite of what the American people want, which is expanded access to coverage. It’s time for this Administration and its sabotage partners in Congress to get the message being sent to D.C. by countless states and take ACA repeal, Medicaid block grants, and administrative actions that diminish access off the table. Enough is enough: it’s time for the GOP to end its war on our health care,” said Protect Our Care Campaign Director Brad Woodhouse.
Winston-Salem Journal // Richard Craver // February 7, 2018
A state child advocacy group has added its voice to those urging the Republican-controlled legislature to expand Medicaid to more than 500,000 North Carolinians
States that have expanded Medicaid have a lower infant mortality rate than those who haven’t, NC Child said in a 2016 report.
An update of that report, which was scheduled to be released today, focuses on fetal mortality, which is defined as the death of a fetus that occurs at 20 or more weeks of gestation.
Both rates are affected by a wide range of factors, including tobacco use and substance use disorders, obesity, domestic violence, poverty, racism, education and access to pre-conception and prenatal healthcare.
In North Carolina, 58 percent of women between the ages of 18 and 44 are considered to be overweight or obese, while 16 percent have been diagnosed with hypertension and 20 percent are smokers.
In 2016, North Carolina had almost as many fetal deaths (818) as infant deaths (873).
From 2012 to 2016, there were 6.9 fetal deaths per 1,000 live births in North Carolina, compared with an infant mortality rate of 7.2 per 1,000 live births.
In Forsyth County, the rate of fetal deaths was 6.4 during that time span, while the infant mortality was 8.3. Forsyth’s highest infant mortality rate was 14.7 in 1997.
“By utilizing available federal funding to expand access to affordable health care for women of childbearing age, the state can influence both fetal and infant mortality simultaneously, effectively doubling the positive impact for North Carolina families,” said Whitney Tucker, research director at NC Child.
Statewide, premature birth and low birthweight are the leading causes of death for infants under 1 year old, causing 20.6 percent.
“These chronic conditions and risk factors can be addressed most effectively when women have access to health insurance,” NC Child said. “Unfortunately, 20 percent of North Carolina women of childbearing age (18 to 44) lacked health insurance in 2016.”
NC Child said 20.5 percent of Forsyth women of childbearing age do not have health insurance, while 31 percent do not receive prenatal care in their first trimester of their pregnancy.
“Newborns of mothers with no prenatal care are three times more likely to have a low birthweight and five times more likely to die than children born to mothers who do receive prenatal care,” according to the report.
NC Child spokesman Rob Thompson said “certain groups of non-citizens are eligible for Medicaid and Obamacare, but not undocumented immigrants.”
“I don’t know exactly what portion of the 20 percent is composed of undocumented immigrants. With children in N.C., 96 percent are insured and the general thinking is that somewhere between one-third and one-half of the remaining uninsured are undocumented.”
Most Republican legislative leaders argue that the federal government, first under the Obama administration and now under the Trump administration, may not be able to keep its pledge of covering 90 percent of the administrative costs of Medicaid expansion.
The advocacy group supports House Bill 662, titled “Carolina Cares,” that represents a bipartisan effort to expand Medicaid. The bill has Rep. Donny Lambeth, R-Forsyth, as its main sponsor.
The bill would require some people who get Medicaid to work, which has proven controversial. North Carolina is one of 10 states with federal regulatory permission to move forward with a work requirement, if legislatively approved.
However, HB 662 has not appeared on either chamber’s agenda for the current special session after not advancing out of committee during the regular 2017 session.
“While the proposal includes elements that will negatively impact enrollment — premiums and work requirements — it has the potential to provide currently unavailable health care options for women of childbearing age at high risk of experiencing fetal or infant mortality,” NC Child said.
“Whether it’s Carolina Cares or a different bill, the legislature should act quickly to close the health insurance coverage gap and support healthy pregnancies and healthy babies,” Tucker said.
Marlon Hunter, Forsyth’s health director, has said the county health department, along with its community and agency partners, encourage women of child-bearing age “to achieve optimal health before they become pregnant in order to improve birth outcomes.”
“Almost half of all pregnancies in our community are not planned.”
The county health department and county Infant Mortality Reduction Coalition are focusing on reducing pre-term birth, supporting and improving mental health services for women, and stressing the importance of women and men of reproductive ages to develop reproductive life plans.
The Kate B. Reynolds Charitable Trust and Novant Health Inc. launched Forsyth Connects in May 2016. Their initiative provides free in-home nurse visits to all mothers with newborn babies who are born and reside in Forsyth. The baby doesn’t have to be the mother’s first.