What the Obamacare Overhaul Could Mean for Texas' Terrible Maternal Mortality Rate

WASHINGTON — Texas officials were already investigating why an alarming number of Lone Star women are dying from pregnancy-related complications when a study last year ranked the state’s maternal mortality rate as the nation’s worst.That’s why many doctors and health care advocates are watching Republican-led negotiations in Washington over replacing the Affordable Care Act, with some worried about what the changes could mean for Texas’ maternal health crisis.Under the House-passed American Health Care Act — now under debate in the Senate — maternal health care could be affected in a number of ways, experts say.For starters, the AHCA could curb future Medicaid spending over a decade by more than $800 billion due to GOP-led concerns over growing Medicaid costs that many warn will saddle Americans with unsustainable debt.Texas would see a drop of as much as $1.5 billion annually in future anticipated funds, according to one study, leaving state officials with tough decisions over how to manage the shortfall. President Donald Trump’s budget proposal would tighten Medicaid spending by another $610 billion.What’s more, some health care providers are concerned that families who purchase insurance on the individual market could lose access to maternity care because of a last-minute amendment in the AHCA that would allow states to pursue a waiver from Obamacare’s 10 essential health care benefits. Those benefits include prenatal care, substance abuse and chronic disease management, among others.If insurers aren’t required to offer those benefits, people like Dr. Lisa Hollier, a Baylor College of Medicine obstetrician who leads the state’s Maternal Mortality and Morbidity Task Force, warn the state could return to pre-ACA days when maternity coverage on a private plan was nearly impossible to find, much less affordable.“Before the Affordable Care Act, there were only a small number of women who had guaranteed maternity coverage through plans, so the loss of the maternity care coverage would have significant negative impacts for women’s health,” said Hollier, president of the American Congress of Obstetricians and Gynecologists.Medicaid concernsShe, like Adriana Kohler, senior health policy associate at Texans Care for Children, an advocacy group, is just as concerned about the future of Medicaid.Texas Medicaid already has strict eligibility requirements, with pregnant women accounting for just 3 percent of those receiving Texas Medicaid. Children, the elderly and disabled comprise the majority.On average, 141,000 Texas women receive prenatal care through Medicaid each month, and Medicaid pays for more than 50 percent of births in Texas. Including federal contributions, Texas spent about $3 billion for deliveries and prenatal costs in 2015, according to state data.Any changes in funding “would pose a real threat to prenatal care for Texas women and undermine efforts to address maternal mortality,” Kohler said. “We don’t have a great history of investing at the state level in a robust way to make up for federal cuts.”Alina Salganicoff, Director of Women's Health Policy at the Kaiser Family Foundation, notes that Trump’s budget proposal would bar abortion providers from receiving federal aid for non-abortion care, such as contraceptive services, which could make it more difficult for some women to receive family planning care. The AHCA would also bar those providers from receiving Medicaid reimbursements for a year.“There are lots of different pieces to this” that could restrict access to family planning services, she said. “That leads to higher unintended pregnancies, especially for women who are at medical risk.”  Continue reading...