Women’s Health Care in Crisis as Republicans Continue Attacks on Basic Rights

Women in the United States have faced insurmountable barriers to accessing basic health care. Historically, American women have suffered the brunt of high health care costs, from insurance premiums to prescription drug prices. The Affordable Care Act (ACA) put in place critical protections to ensure women could not be charged more than men for the same coverage and that they could access services like preventive screenings and contraception at no additional cost. As a result of the ACA, millions of women gained coverage and health outcomes improved across the board. 

Yet barriers to accessing care remain, particularly for women of color and low-income women, and additional measures are necessary to ensure everyone can meet their basic health care needs. As Republican attacks and inaction continue, lack of health care access has continued to drive the U.S. maternal mortality crisis, which claims hundreds of lives every year. It prevents women from accessing contraception and essential reproductive services, and it limits women with chronic conditions from paying the bills or caring for their families. 

Making matters worse, right-wing attacks on women’s health care have only amplified in recent years. Between seeking to undermine the ACA, to refusing Medicaid expansion and fighting measures to combat maternal mortality, Republicans have done nothing but limit access to essential care for women. And as a pending Supreme Court decision threatens to upend abortion rights, strengthening access to affordable, quality health care for women and their families has never been more urgent. 

Republican Attacks On Women’s Health

Republicans have been waging a war on women’s health for years, from blocking postpartum Medicaid coverage to defunding reproductive health care, Republicans at every level of government will stop at nothing to pander to the most fringe elements of their political base. Here’s a look at some of their most outrageous attacks: 

  • Attacking Equal Coverage. In addition to House Republicans taking 100 failed votes to repeal the Affordable Care Act, they have also taken their fight to overturn the ACA all the way to the Supreme Court three times, and failed three times. The ACA made enormous strides for women’s health. By taking these actions, Republicans are fighting to strip protections from women that provide access to lifesaving preventative care, such as mammograms, bone density screenings, and well woman visits. 
  • Postpartum Health Coverage & Maternal Mortality. American women suffer from horrifying rates of maternal mortality. The solutions to this devastating problem are well within reach, however Republicans simply refuse to take action, and at times, actively fight against lifesaving measures, such as extending postpartum Medicaid coverage. Not a single Republican member of the House voted for legislation that included the The Black Maternal Health Momnibus Act, which is essential to addressing this ongoing crisis. 
  • Contraception Coverage. Republicans have a long pattern of bulking at women’s reproductive health, despite the fact it has been pivotal to advancing gender equity in the U.S, allowing women to participate in the workforce and society at large. From undermining state and federal family planning programs to seeking legal challenges that go all the way to the Supreme Court, Republicans are shameless in their attempts to curtain birth control access and coverage. 
  • Abortion. After decades of unrelenting attacks on abortion access, Republicans are poised to overturn Roe. This devastating outcome would ultimately ban abortion in large swaths of the country, forcing Americans to continue unwanted pregnancies if they are unable to travel to other states. While Republicans have wasted no times crafting extreme abortion restrictions that will take place in the event Roe is overturned, they have completely neglected the wellbeing of mothers and children who will be forced to suffer the consequences of their poltical games. 

The ACA’s Contraceptive Coverage Requirement Is Needed Now More Than Ever

Ten years ago, the Affordable Care Act’s contraception coverage requirement became the law of the land, drastically improving health care access and affordability for millions of women. The benefits have been far reaching — improving health outcomes and sharply cutting out-of-pocket costs. Despite the overwhelming success of the ACA’s contraception coverage, Republicans have attempted to eliminate this essential care year after year. With the protections of Roe likely to be overturned, the ACA’s contraception coverage is more important than ever before. 

The State of Contraceptive Coverage 

Contraception As Preventive Care. The ACA requires coverage for many preventative services for women including screenings for cancer and certain diseases, well woman visits, and of course, contraception. Currently, the FDA has approved 18 methods of contraception and the  ACA guarantees women access to at least one form of contraception in each category, including oral pills, IUDs, sterilization surgery, and emergency contraception to name just a few. These methods must be provided without cost sharing, even if a deductible hasn’t been met. 

Who Uses Contraception? More than 99 perent of sexually active women between the ages of 15 and 44, have used at least one form of contraception, with 65 percent of women in this age group currently using some method of birth conrol. While religious beliefs have often been used to justify refusing contraceptive coverage, nearly all women who identify as religious have used a method of contraception in their lives, including 99 percent of Protestants, evangelicals, and Catholics, and 96 percent of women belonging to other religious affiliations. 

Millions Benefit. Today, 63 million women have free contraception because of the ACA. In the ACA’s first year alone, women saved $1.4 billion on their birth control. Before the ACA’s contraception benefit, women paid an average of 30-44 percent of their total out-of-pocket costs towards birth control.

Coverage Equity Increases Access To Contraception. Thanks to the ACA, insurers can no longer charge women more than men for the same coverage. Between 2010 and 2015 alone, nearly five million women of reproductive age gained health insurance because of the ACA, allowing them to access free, quality contraception on equitable coverage plans. 

President Biden’s Work To Protect Contraceptive Access

Shortly after taking office, President Biden and Congressional Democrats passed the American Rescue Plan, which lowered premiums for middle and working class women, expanded coverage for millions who were previously uninsured, and increased access to essential health benefits, like contraceptive care, and incentivized Medicaid expansion. Thanks to President Biden’s leadership, 2022 saw 5.8 million Americans newly insured by an ACA plan and a total of 87 million Americans receiving their coverage through Medicaid or CHIP. 

Increasing Access To Marketplace Plans. In 2021, 14.5 million people signed up for health coverage through an ACA Marketplace. ACA Marketplace plans are required to cover contraception and counseling for all women. Premium savings under the American Rescue Plan benefit millions of Americans, with families now saving an average of $2,400 a year on their health insurance premiums.

Expanding Medicaid, The Largest Payer Of Reproductive Health Care Coverage. Under President Biden, 21 million Americans are now covered under the ACA’s expansion of Medicaid. Two thirds of women enrolled in Medicaid are of reproductive age, with Medicaid accounting for 75 percent of all public expenditures on family planning services. Two studies from Michigan showed that Medicaid expansion doubled low-income patients’ access to primary care, and that enrollees experienced improved access to birth control and family planning. 

Eliminating Premiums For Low-Wage Workers. 28 million women in the U.S. are low-wage workers, with Black (54 percent) and Hispanic and Latina (64 percent) women disproportionately experiencing low-wages. The American Rescue Plan eliminated premiums for Americans earning up to 150 percent of the federal poverty level (roughly $20,000 for a single person and $41,000 for a family of four) who buy their coverage on the Marketplace.

Medicaid Is Essential To Women’s Health

Medicaid is an essential pillar in providing coverage for women, which is why President Biden and Democrats in Congress have fought tirelessly to expand Medicaid coverage and access across the nation. Generations of inequality have resulted in women experiencing high coverage costs, poor health outcomes, and health inequities. As a result, Medicaid coverage remains a critical source of coverage, especially for women of color who experience higher rates of poverty than white women and remain less likely to have access to quality care.

Research confirms that Medicaid expansion saves lives and drastically reduces health disparities. States that expanded their Medicaid programs saw millions of women gain coverage. In 2019, eight states with women’s uninsured rates above the national average had not adopted Medicaid expansion. By rejecting expansion, these states are worsening the maternal health crisis and limiting health care access for the women who need it most. Despite Medicaid expansion’s proven role in reducing disparities in health care access and improving outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated four million uninsured adults are locked out of coverage in the 12 holdout states, with 2.2 million trapped in the Medicaid coverage gap. As of 2021, approximately one million women are in the coverage gap.

Medicaid Covers Over 30 Million Women Nationwide. 31 million adult women rely on Medicaid for coverage. Women comprise the majority of adult Medicaid enrollees, and in 2020, Medicaid covered 16 percent of nonelderly women in the United States. 

Medicaid Is A Major Source Of Coverage For Women Of Color. Due to systemic inequality, women of color are disproportionately likely to be covered by Medicaid. Nearly 33 percent of Black Americans, 30 percent of Hispanic or Latino individuals, nearly 15 percent of Asian and Pacific Islanders, and 34 percent of American Indian and Alaska Native individuals are enrolled in Medicaid, compared with 15 percent of white individuals.

Medicaid Covers Nearly Half Of Women With Disabilities. Medicaid covers more than 44 percent of nonelderly women with mental and physical disabilities. As of 2019, Medicaid was the source of health coverage for one in four American women with mental illness.

Most Women On Medicaid Are Working. According to Kaiser Family Foundation, the vast majority of women enrolled in Medicaid work, including mothers on Medicaid. In 2019, 93 percent of women enrolled in Medicaid were either working, going to school, at home caring for young children or relatives, or experiencing an illness or disability that does not permit them to work. 

Medicaid Improves Access To Care For Women. Women with Medicaid are far more likely to receive care than uninsured women. According to the Kaiser Family Foundation, women with Medicaid coverage are less likely than women with private insurance to report delaying or forgoing care due to cost. Women with Medicaid coverage receive preventive care at roughly the same rates as women with private coverage and at a higher rate than women without insurance. 

Medicaid Helps Pay For Long-Term Care, Mostly For Elderly Women. Medicaid pays for roughly half of the nation’s long-term services and supports. In 2020, women accounted for 61 percent of the 12.3 million dual-eligibles, or people who rely on both Medicare and Medicaid for coverage. Most dual-eligibles are elderly, and many need Medicaid coverage for their long-term care needs. Medicaid covers nearly 40 percent of Latina and Black women over 65 who are also covered by Medicare.

Medicaid Creates Jobs In The Health Industry, Which Is Overwhelmingly Female. Kaiser Family Foundation estimates that there are 15.5 million frontline health care workers — 77 percent of which are women — establishing Medicaid as a major job creator for women. 

Improving Maternal Health & Fighting Racial Disparities

As Republicans celebrate the anticipated overturning of Roe, attack contraception access in the courts, and block expanded access to maternal health care in state legislatures, American women continue to suffer the highest rates of maternal mortality in the industrialized world. It is unconscionable that in the wealthiest nation on earth, the majority of maternal deaths are not only preventable, but on the rise. The United States is only one of two nations that has experienced a significant increase in maternal mortality over the past 20 years. The cause and solution to this problem is clear. 

The United States routinely strips new mothers of their insurance coverage, just weeks after giving birth. Despite Democrats single-handedly passing the American Rescue Plan, which provides all states an easier pathway to extend postpartum Medicaid coverage to a full year, Republicans across the nation continue to drag their feet. As of May 2022, 29 states and the District of Columbia have already extended this coverage, or are planning to do so. Republican leaders refusing this expansion demonstrate a shocking disregard for women’s health, with 24 percent of maternal deaths occurring more than six weeks after delivery, near the same time women are being purged from the Medicaid program, the nation’s largest single financier of child birth. Those bearing the brunt of this crisis — Black, American Indian, and Alaska Native women — have experienced staggering rates of maternal mortality generation after generation. 

The Black Maternal Health Momnibus Act would provide millions in funding to address the root causes of America’s maternal mortality crisis. In addition to advocating for 12-month post-partum Medicaid coverage, the Black Maternal Health Caucus drafted the Mominbus with provisions including: funding to address social determinants of health contributing to maternal mortality, funding to grow and diversity the priental workforce, and providing health care workers with the tools and training necessary to confront discriminatory and biased practices. 

America’s Maternal Mortality Crisis

U.S. Maternal Mortality Rates Are The Highest In The Industrialized World And Rising. When compared with 10 other industrialized nations, the United States has the highest rate of maternal mortality by far, with American women dying at a rate more than double that of other industrialized countries. The United States is only one of two nations that has reported an increase in maternal mortality since 2000. In 1987, the CDC reported 7.2 deaths for every 100,000 live births, with the rate increasing to 23.8 in 2020.

Maternal Deaths Following Delivery. The CDC has found roughly 24 percent of maternal deaths occur during pregnancy, with 34 percent occurring on the day of delivery or within seven days, and 24 percent, occurring more than six weeks after giving birth, underscoring the need for access to quality, postnatal health coverage well beyond 60 days.

Most Pregnancy-Related Deaths Are Preventable. The CDC reports nearly two thirds of pregnancy-related deaths could have been prevented. In order to prevent pregnancy-related deaths, it is essential women have access to care, so medical professionals are able to recognize early maternal warning signs, provide an accurate and timely diagnosis, and deliver quality medical care. 

Addressing Late Maternal Deaths. Maternal deaths occurring between 42 and 365 days following delivery are categorized as late maternal deaths. Cardiomyopathy and other cardiovascular conditions accounted for 27 percent of maternal deaths from 2014 to 2017, with cardiomyopathy serving as the leading cause of late maternal deaths. American women experience a higher rate of late maternal death than their counterparts in other industrialized nations. Insurance enrollment is a critical element in preventing premature death, by ensuring these conditions, specifically cardiomyopathy, are identified early and treated appropriately.

Women Of Color Are Acutely Impacted By The Maternal Health Crisis

Racial Disparities Have Worsened Over The Last Century. While the United States has made progress in addressing maternal mortality since the beginning of the 20th century, it has been unsuccessful in reducing racial disparities in maternal mortality. In 1915, the maternal mortality rate for Black women was 1.8 times higher than for white women, with disparities increasing in subsequent decades. In 2018, the maternal mortality rate for Black women was  3.2 times higher than for white women — the same disparity recorded 80 years ago. American Indian and Alaska Native women have a maternal mortality rate 2.3 times higher than white women. For Black, American Indian, and Alaska Native women over 30, the rate of maternal mortality is four to five times higher than for their white counterparts. 

Social Determinants Of Health And Maternal Mortality. Addressing social determinants of health is essential to ending racial disparities in maternal mortality. However, the Center on Budget Policy and Priorities found “there is now consensus…that disproportionately high maternal mortality and morbidity among Black women, regardless of income and education, are due to structural racism in the delivery of health care services along with their lived experiences of racism.” Higher educational attainment and income level do not have the same degree of benefit in reducing maternal mortality in Black women as they do for white counterparts. A maternal mortality report released by HHS in 2007 found racial disparities persisted despite poverty status. Black women living below the federal poverty line experienced maternal mortality at a rate three times higher than their white counterparts at the same income level. Any effective approach to eliminating racial disparities in maternal health will need to address social determinants of health — like access to quality, affordable health care and health coverage — while equally addressing racism’s pervasive influence in our society and its manifestations in health care delivery. 

Expanding Medicaid And The Black Maternal Health Momnibus Act Will Improve Maternal Health

The Black Maternal Health Momnibus Act would provide millions in funding to address the root causes of America’s unprecedented maternal mortality crisis. In addition to advocating for 12-month post-partum Medicaid coverage, provisions in the legislation include: addressing social determinants of health, funding health equity research and practices, and providing health care workers with the necessary tools to confront discriminatory and biased practices. 

Strong Maternal Health Relies On Medicaid

Access To Care Is Essential At Every Stage. There is an urgent need for quality, affordable health coverage prior to, during, and after giving birth. Approximately 24 percent of maternal deaths are deemed ‘late’, occurring between six weeks and one year following delivery, demonstrating the immense need for continuous health access and coverage for a minimum of one year following the birth of a child. 

More Than Four In 10 Births Are Covered By Medicaid. In 2018, 42 percent of births were financed by Medicaid, with 40 percent or more births covered by the program in 25 states. Rates varied across the nation, with 61 percent of births financed by Medicaid in Louisiana, and 22 percent in Utah. In the 12 states that have refused Medicaid expansion, eight had more than 40 percent of births covered by Medicaid. Medicaid covers 65 percent of all births to Black mothers. 

Closing the Medicaid Coverage Gap Is Critical To Improving Maternal Health. Women of color consistently experience higher rates of maternal mortality than white women, with the Center on Budget Policy and Priorities finding this to be the result of a combination of factors, including life-long toxic stress resulting from racism and the impacts of structural racism in the health care system. If post-partum Medicaid coverage was expanded to a full year, more than 720,000 individuals would receive quality coverage. 65 percent of women of reproductive age living in the coverage gap are women of color. 

Confronting Social Determinants Of Health & Systemic Racism In Health Care

Millions Would Be Invested To Address Social Determinants Of Health. The Black Maternal Health Momnibus Act provisions contain $60 million to address social determinants of maternal health at the local level. Additional funding is provided for once-in-a-generation investments in housing, nutrition, and environmental conditions with the explicit focus of improving maternal health. 

Funding Health Equity Measures. The Momnibus includes $120 million to bolster and diversify the perinatal health workforce, including funding for midwives and doulas whose involvement is essential to reducing maternal deaths. An additional $75 million has been included for maternal mental health equity and $40 million for maternal health research at Minority-Serving Institutions.

Directly Confronting Systemic Racism in Maternal Care. $20 million for training to address racism, discrimiation, and bias is included in the Momnibus. This training for health care professionals is just one of the many necessary steps required to begin addressing racism in the American health care system and improve maternal health equity.