While some have framed the proposal as a way to help pregnant women, there is little evidence such a proposal would actually help women. Under SB 2033, Medicaid coverage for women would be covered for 12 months instead of the current 2 months required by federal law. This proposal has been sold as a “pro-life” bill because it expands taxpayer-subsidized insurance to women. This logic is deeply flawed, and, frankly, insulting to the pro-life movement. In addition, there is little evidence that this bill will reduce either maternal mortality or infant mortality in Mississippi.
Expanding Postpartum Medicaid Coverage is Not Pro-life
Expanding Medicaid to able-bodied adults is not pro-life. There are several reasons for this.
In the first place, it is important to note that Mississippi Medicaid actually covers abortion in limited, but morally questionable, cases. Federal law requires Mississippi Medicaid to pay for abortions in cases of rape and incest. In addition, Mississippi has opted to allow for Medicaid coverage of abortions in cases of "fetal impairment," which could include chromosomal abnormalities such as Down syndrome. This policy potentially conflicts with the state's Life Equality Act passed in 2020, which explicitly prohibits abortions on the basis of a genetic abnormality.
Therefore, any expansion of Medicaid in the state to women of child-bearing age must be understood as an expansion of state-funded abortion within these parameters. This is especially true for the current proposal to expand postpartum Medicaid, which of course exclusively applies to women of child-bearing age.
Furthermore, postpartum Medicaid expansion creates the potential for a perverse incentive that could ultimately lead to women having more frequent abortions.
Under federal law (42 C.F.R. § 440.210(a)(2)(i)-(ii)), postpartum Medicaid coverage applies as follows:
"For women who, while pregnant, applied for, were eligible for, and received Medicaid services under the plan, all services under the plan that are pregnancy-related for an extended postpartum period. The postpartum period begins on the last day of pregnancy and extends through the end of the month in which the 60-day period following termination of pregnancy ends."
On the surface, it might seem that postpartum coverage applies to women who carry their baby to birth, but federal law defines the period as beginning “following termination.” That seems to include abortion and involuntary miscarriage.
If a woman ends a pregnancy through abortion, she would theoretically be eligible for postpartum Medicaid for 12 months after she ended the pregnancy, just in the same way as a woman who had naturally miscarried or carried her baby to full term.
Theoretically, this means that a woman could have an abortion every 12 months and stay on Medicaid indefinitely. This is all the more possible insofar as SB 2033 does not require any ongoing eligibility checks.
More problematic is that Medicaid is a major source of funding for Planned Parenthood. According to the Charlotte Lozier Institute, government funding for Planned Parenthood, including Medicaid, is almost $1.7 million per day.
The Hattiesburg Planned Parenthood accepts Medicaid. Included among the services they offer are “abortion referrals,” “the morning-after pill” and “LGBTQ services.”
Mississippi also covers “family planning” for one year after a pregnant woman enrolls in Medicaid. This family planning waiver is incredibly generous in terms of the categories covered: women and men earning up to 194 percent of the federal poverty level ($55,236 for a family of four) and including individuals aged 13 to 44. It is presumed that Planned Parenthood is a major provider of services under this waiver in Mississippi.
Expanding Medicaid postpartum from 2 months to 12 months, however, will benefit Planned Parenthood even more, as women who have just had a baby are more likely to use contraception to space out childbirth. Indeed, the average time between births in the United States is about 26 months. Expanding postpartum coverage to 12 months, at a minimum, allows women who are not eligible for family planning services to access these services – again, to the benefit of providers like Planned Parenthood.
Medicaid Already Covers Parents and Caretakers of Children
The most misleading aspect of this attempt to expand Medicaid to able-bodied adults is the failure to disclose that Medicaid already covers the parents of children on Medicaid!
According to the Mississippi Division of Medicaid:
"Parents or caretakers must have children under age 18 living in the home, who are deprived of the support of one or both parents due to the disability of a parent, the death or continued absence of a parent or have parent(s) who are unemployed or have very low income."
This means that parents who are unemployed, single or who have very low income are already eligible for Medicaid. Who, then, does this Medicaid expansion cover?
This hardly sounds like the vulnerable population Mississippi taxpayers are being led to think will benefit from this Medicaid expansion.
In addition, it’s worth pointing out that while the federal government covers about 85 percent of the costs of Medicaid coverage, women that enroll on the Obamacare exchange are covered at 100 percent. And, under the Biden administration, eligibility categories for Obamacare have increased expansively.
An additional concern is that every expansion of Medicaid actually increases costs for those on private insurance. Thus, while expanding Medicaid to 12 months for postpartum women might seem like an idea that would lower healthcare costs, it actually has the potential to increase costs for everyone else.
Maternal and Infant Mortality Claims Need Further Study
Many of the arguments for postpartum Medicaid expansion are based upon claims that Mississippi has among the highest rates of postpartum mortality. Some have claimed that the reason for these statistics simply must be a lack of government health care.
Many of the advocates for postpartum Medicaid expansion have referenced a report produced by the Maternal Mortality Review Committee, claiming that the report demonstrates the need for postpartum Medicaid expansion. These committees are funded by grants from the Centers for Disease Control and, predictably, always arrive at the same conclusion: expand Medicaid.
The claims that are being drawn from the Mississippi report require additional study, to say the least.
A careful reading of the data in the report reveals that many of the deaths listed in the report have little or nothing to do with pregnancy. For example, there are a total of 136 deaths listed in the report from 2013 to 2016. Many of these deaths were unrelated to pregnancy and largely unpreventable from a health insurance perspective. This includes motor vehicle accidents (24 percent), homicide (7 percent), fire (3 percent), and other causes that had little to do with pregnancy.
Even more to the point, Mississippi’s report acknowledges the following:
"The majority of maternal deaths occurred in the postpartum period including 37% occurring after 6 weeks and involve women insured by state Medicaid (p. 23)."
In other words, the majority of maternal deaths involved women ALREADY on Medicaid. It is beyond dispute that Medicaid health outcomes are not very good – in fact, worse than the uninsured, who tend to pay cash for healthcare (see, for instance, J. Taylor: “Medicaid: A Government Monopoly that Hurts the Poor” (2018)). But if even the Maternal Mortality Review Committee is acknowledging that the majority of maternal deaths involve women on Medicaid, it seems obvious that expanding Medicaid to postpartum women is a bad idea. Indeed, it may be Medicaid that is the problem.