Congress, White House plan action on maternal health policies

Maternal mortality, or death during or up to a year after childbirth, is a growing problem in the United States

Vice President Kamala Harris led the Senate effort for the so-called "Momnibus" package   when she was a California senator.  (Tom Williams/CQ Roll Call)
Vice President Kamala Harris led the Senate effort for the so-called "Momnibus" package when she was a California senator. (Tom Williams/CQ Roll Call)
Posted May 4, 2021 at 10:29am

The White House and lawmakers are seeking to build momentum on what they view as a more comprehensive policy solution to address the nation’s rising rates of maternal mortality and morbidity.

Advocates and lawmakers are working on comprehensive legislation to curb maternal deaths, which has emerged as a bipartisan priority in recent years.

Maternal mortality, or death during or up to a year after childbirth, is a growing problem in the United States. The U.S. has the highest maternal mortality rate of any developed nation.

The maternal mortality rate was 20.1 per 100,000 live births in the U.S. in 2019, according to the Centers for Disease Control and Prevention. That number was more than double the rate — at 44 deaths per 100,000 live births — for non-Hispanic Black women.

Experts are concerned about how the pandemic may have exacerbated maternal mortality rates, especially in communities of color.

Minorities have suffered disproportionately at the hands of the pandemic with Black, Hispanic and American Indians experiencing much higher rates of hospitalization and death compared to white individuals. That, coupled with economic and access issues over the past year, raises concerns that the problem could get worse.

A Robert Wood Johnson Foundation and Urban Institute brief said evidence is currently limited about how the pandemic has affected the quality of maternal care and if policies adopted during the past year, like expanding telehealth, helped reduce inequities.

“When the pandemic began, interviewees noted that attention and funding shifted away from maternal health efforts. Health, public health, social service, and other systems were unprepared,” the authors wrote.

But movement on new policies on the legislative and executive fronts could help curb some of these disparities.

The House Oversight and Reform Committee is slated to hold a hearing examining the Black maternal health crisis on Thursday. The committee and the Black Maternal Health Caucus plan to hold a joint press conference before the hearing.

The Black Maternal Health Caucus is planning an additional announcement pegged to Mother’s Day on Sunday to raise awareness for the issue.

A strategy to tackle poor maternal health outcomes must be multi-pronged, experts said.

“There is no one entity or no one organization that can take on this problem,” said Laurence Polsky, an obstetrics and gynecology specialist from Prince Frederick, Md. He emphasized that care needs to be coordinated between specialists, hospitals and public health workers.

Congressional concern

The recent COVID-19 relief law included language that would temporarily allow states to expand Medicaid coverage for women up to one year postpartum. But other broader policies are also in the works.

A leadership-backed legislative package combines language from 12 smaller bills that would address social determinants of health, broaden and diversify the perinatal workforce, improve data collection and provide funding to community organizations that focus on maternal health.

The so-called Momnibus package has been introduced before. But this time, sponsors hope they have a leg up, in part because the previous Senate leader on the package, Kamala Harris, is now the vice president.

“In Congress, when you don’t get it all the way through you go back and do it again,” said Rep. Alma Adams, D-N.C., a co-chair of the Black Maternal Health Caucus. "With the leadership in the House and Senate and the White House, we’re pushing hard to get the bill over the finish line.”

Adams is pushing for the entire package to move as a complete entity. Her communications director, Sam Spencer, said different committees are taking up portions of the bill.

The House Veterans’ Affairs Health Subcommittee held a hearing last month on one of the bipartisan bills included in the Momnibus. The bill from Black Maternal Health Caucus co-chair Lauren Underwood, D-Ill., would improve care coordination for pregnant and postpartum veterans.

“We’re working to get more individual bills onto the respective Committee and Subcommittee calendars for markups,” said the aide.

A senior House Democratic aide who was not authorized to speak for attribution echoed that the committees are still working on the package, and the timeline is fluid.

The Black Maternal Health Caucus is planning an additional announcement pegged to Mother’s Day on Sunday to raise awareness for the issue.

Speaker Nancy Pelosi has endorsed the Momnibus, and Senate Majority Leader Charles E. Schumer also has called for addressing racial maternal health inequities.

Majority Leader Steny H. Hoyer, a member of the Black Maternal Health Caucus, called the Momnibus “critical” during a maternal health roundtable he hosted April 26.

Efforts to address maternal disparities are bipartisan.

Rep. Jaime Herrera Beutler R-Wash., a co-founder of the Maternity Care Caucus and author of a 2018 law to prevent maternal deaths, is also looking for solutions.

She is pushing for a bipartisan bill to improve obstetric care in rural and remote areas. She is planning to reintroduce a bill that would provide grants for supporting midwifery education that would in part prioritize increasing racial and ethnic minority representation.

Herrera Beutler and Underwood both sit on the House Appropriations Committee, which looked into the maternal crisis in March.

Underwood, although she is not on the Labor-HHS-Education Subcommittee, has said she will fight to increase funding for maternal and child services block grants, maternal health research at the National Institutes of Health and Maternal Mortality Review Committees.

White House steps

The White House also is focusing on policy efforts that could curb maternal deaths.

Black Maternal Health Week in mid-April was honored by its first-ever White House proclamation. That week, Harris — who has a long-standing interest in the issue — hosted a roundtable with domestic policy adviser Susan Rice on Black maternal health, where she emphasized a whole-of-government approach.

An aide to Harris reiterated the vice president’s record and continued focus on the issue.

“The Vice President believes that systemic racism and implicit bias, not only in the health care system, but broadly as we look at other social determinants like transportation, environment, housing, education, all contribute to a maternal mortality rate that is 2-3 times higher for black mothers than white mothers,” the official said in an email.

The White House fiscal 2022 budget request asks for $200 million to expand maternal care, decrease implicit bias and fund Maternal Mortality Review Committees, which review local death data up to one year postpartum to help the CDC make recommendations.

In April, the Department of Health and Human Services opened applications for a $12 million grant that would improve maternal care in rural communities.

Medicaid covers about 20 percent of women of reproductive age, according to the Centers for Medicare and Medicaid Services, so its policies can make a difference.

In mid-April, HHS approved the first waiver that would extend postpartum Medicaid coverage beyond 60 days up to 12 months in Illinois. Since then, Georgia and Missouri had similar waivers approved.

On April 27, 15 health organizations wrote to CMS Acting Administrator Elizabeth Richter, asking her to work with additional states to apply for the postpartum waiver and to issue guidance to states on how to take advantage of the new policy.

HHS Secretary Xavier Becerra has said several states already expressed interest.

“We want states to join in. We want them to come on board,” he said at a recent HHS event. “I hope that we begin to see states not only express interest but also submit their proposal on how to do this.”