You know the old saying about hard-won progress being “two steps forward and one step back?” The Missouri General Assembly doesn’t often meet even that low standard when it comes to expanding Medicaid to the people who need it. State leaders in Jefferson City are on the cusp of delivering an important victory for needy mothers — but they could also produce yet another disappointment.
The good news is that the state Senate gave initial approval last week to a bill that would expand postpartum Medicaid coverage from the current 60 days to a full year. The move comes a year after a similar effort failed in the legislature. This time, though, the effort was backed by a coalition of women senators on both sides of the political aisle.
If it gets final approval, an estimated 4,600 new mothers in the state of Missouri could benefit. Officials say that 61 Missouri women die every year either while pregnant or within a year after giving birth — giving the state the 12th-highest maternal mortality rate in the country.
It’s not a perfect bill: It would require nearly 5,000 Missourians to come off the Medicaid rolls before the postpartum expansion can begin. But officials say that many more people would organically lose their eligibility over the next year because a temporary federal expansion of Medicaid for the COVID-19 emergency is coming to an end.
“I think it is a good bill,” said Timothy McBride, a Medicaid expert at Washington University’s Brown School in St. Louis. But it is also “probably overdue,” he said. “And other states have done this already.”
Don’t celebrate just yet.
The effort could still easily fail — not because of lack of support, necessarily, but because of provisions added by conservative lawmakers that deny postpartum Medicaid coverage to patients whose pregnancies end because of abortion. That probably runs afoul of federal rules for the program, which mandate that post-pregnancy coverage shall be available “regardless of the reason the pregnancy ends.”
If Missouri keeps the antiabortion language, then expanded coverage for new mothers might never come to fruition. That would be a tragedy.
It is outrageous that we even have to have this debate. Many abortions, especially later in term, are for medical necessity. Other countries with advanced economies routinely and automatically offer postpartum care and coverage — along with paid family leave — regardless of a family’s income. The United States doesn’t. The result? America has a maternal mortality rate that doubles other high-income countries.
And when it comes to Medicaid, the Missouri legislature hasn’t really earned the benefit of the doubt.
Our leaders dragged their heels on Medicaid expansion so long that the state’s residents finally forced a referendum on the issue through a petition initiative. When expansion won, state leaders resisted implementing it anyway — doing so only after a judge ordered Gov. MIke Parson to open up the rolls to eligible Missourians. The state’s Republican leaders apparently resent that assertion of citizen power so much they’re now working to raise the threshold for future referendums to succeed.
Time and again, GOP officials have stood in the way of good policy on this issue. We would hate to see this awful history repeat itself.
Rather than merely castigate legislators for their recalcitrance, though, we would like to encourage conservative legislators to broaden their perspective. Until now, they have mostly focused on passing laws that outlaw abortion or — in the case of the provisions in the Medicaid bill — punish women who receive abortions by denying them state services. They have been less diligent about ensuring that Missouri is a state where it is medically safe to carry a pregnancy to term, and where new families can flourish even if they face income limitations.
Passing a postpartum Medicaid bill — with no unnecessary conditions that would scuttle the effort — could well be the single most truly pro-life act state leaders have taken since the Supreme Court overturned Roe v. Wade last year.
The Missouri General Assembly is perilously close to failing again. But it is also on the cusp of getting this issue right. We can only hope that lawmakers defy expectations.
