My State Has the Highest Maternal Death Rate—Stacey Abrams Plans to Change That

Georgia is one of 17 states that has not expanded Medicaid coverage under the Affordable Care Act. By refusing to do so, the state turned away federal funding that would essentially open the door for people like me to access health care.

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Nov 5 2018, 6:03pm

The author and her daughter. Photo by Farrahn T Photography.

Three weeks before she was due, my daughter Kalina came charging into the world on February 3, 2016. I woke up about eight in the morning with labor pains, and by 2:30 that afternoon, I held a screaming human in my arms.

Like my daughter’s arrival, my pregnancy was unexpected. (In fact, about 45 percent of all pregnancies in the US are unplanned.) After nine years working at a weekly newspaper in North Carolina, I decided to move home to Georgia to be with the people I loved and focus on writing. Moving in with my boyfriend and planning a freelance career would be an adjustment, but it was time for a new adventure.

We conceived a child before I’d even finished unpacking my boxes. When I found out two months later, I cried. Not only because this was not the new adventure I’d envisioned, but also because I had no idea what to do: I’d given up my insurance when I’d left my full-time job. After deciding to keep the baby, I now had an urgent need to find regular health care and had no way to pay for it.

Fortunately, as a pregnant woman with no income, I qualified for Medicaid, the federal and state partnership that helps provide health care coverage to people with limited income and/or disabilities. According to the Kaiser Family Foundation, Medicaid covers the costs associated with approximately half of all births in most states, including Georgia.

Because of Medicaid, all of my prenatal care as well my hospital stay and delivery were taken care of. I delivered a healthy baby and had no major health concerns during or after my pregnancy.

But on April 4, 2016, I was once again uninsured. In Georgia, a woman who qualifies for Medicaid under the pregnancy option remains covered up to 60 days after the birth of her child. After that, she can reapply for and get approved for Medicaid, as long as she makes less than $40,656 (for a household of two) or meets a list of other qualifying factors, such as a breast or cervical cancer diagnosis, blindness, a disability, or is over the age of 65.

Georgia is one of 17 states that has not expanded Medicaid coverage under the Affordable Care Act. By refusing to do so, the state turned away federal funding that would essentially open the door for more people to access health care. What’s even more concerning is that a recent report from the National Partnership for Women and Families found that Georgia has one of the lowest rates of coverage for women in the country.

That’s why Stacey Abrams, the Democratic candidate for governor in my state, has made Medicaid expansion one of the top issues in her campaign. If Abrams is elected—and manages to convince a Republican-majority state legislature to get on board with expanding the program—nearly half a million people would be able to access important health care through Medicaid.

Abrams, who could become the country’s first black female governor, also argues that Medicaid expansion would help to address the state’s high maternal and infant mortality rates. Currently, health officials believe Georgia has the worst maternal death rate in the country, and it appears to have only gotten worse in recent years.

In a statement, Abrams said her goal is to reduce maternal and infant mortality rates by “funding rural hospitals, expanding Medicaid, and leveraging state and federal programs to incentivize doctors and medical personnel to live in underserved communities.” According to her health care platform, more than half of Georgia counties do not have an OB/GYN provider; expanding Medicaid, the plan states, would fund hospitals in those underserved areas and in turn give more women access to high-quality care, ultimately leading to better health outcomes.

“Georgia’s high maternal and infant mortality rates highlight the importance of access to quality, affordable health care for Georgia mothers and children throughout our state."

“Our state is in crisis,” Abrams said. “Georgia’s high maternal and infant mortality rates highlight the importance of access to quality, affordable health care for Georgia mothers and children throughout our state. I am the only candidate to make maternal health a centerpiece of my health care platform.”

Meanwhile, Abrams’ opponent Brian Kemp has repeatedly called Medicaid a “failed” program that would cost too much to expand. He told Georgia Health News recently: “Taking money away from public safety and education to expand up a failed government program will only make things worse.”

According to recent research published in Health Affairs, states that did not expand Medicaid saw a decline in the number of new mothers who were insured. Between 2013 and 2016, the uninsurance rate fell from 25.3 percent in 2013 to 17.9 percent in 2016.

When I lost Medicaid in 2017, I lost the opportunity to seek follow-up care with my OB/GYN. I saw my doctor twice after Kalina was born: about two weeks after my delivery, and then again at the six-week mark. He scheduled my annual pap smear for a couple months later, but the date fell after my insurance was dropped. I never went.

Because I didn’t have any complications during my pregnancy, I didn’t have an urgent need to see my doctor again. I was lucky. Every year, more than 50,000 women in the US experience a severe complication with pregnancy. (It’s one of the reasons why the American College of Obstetricians and Gynecologists recently updated its recommendations about postpartum care, pushing for providers to offer “ongoing care” instead of just that one-time visit that usually occurs four to six weeks after birth.) How are those women supposed to get the postpartum care they need if their insurance drops them just two months after delivery?

I still don’t have insurance. It’s actually been three years since I’ve had a women’s well visit. Last year, I planned to finally sign up through the ACA marketplace because my income via freelancing was consistent enough that I thought I could afford it. I discovered, however, that the monthly premium for the least amount of coverage, even with tax credits, was still too expensive for me. Like many other women, I fall in a coverage gap: I earn too much to qualify for Medicaid, and too little to get coverage through the marketplace.

Of course, it’s also important to point out that Georgians without children (and who are not disabled) are ineligible for Medicaid regardless of how low their income is.

That’s why 33-year-old Jasmin Stiger is currently uninsured. She’s unemployed, deals with depression and anxiety, and has no children. “I’ve never qualified for Medicaid, no matter how many times I’ve applied,” she tells Broadly. In her adult life, she’s gone back and forth between having really good insurance through work and no coverage at all.

On the several occasions she’s applied for Medicaid coverage—the last time being summer 2017—she has been denied, which makes obtaining her medications difficult. “Each time I’ve applied, the biggest thing is, I don’t qualify because it’s just me,” she says. “Here I am with no child and it’s almost like, what is the government looking at me as? I’m not worthy of even elementary health care without paying for it? No income, very small family size, no pre-existing condition—and no ability to qualify for anything.”

According to a brief from The Urban Institute, Medicaid expansion in other states has helped more low-income, childless adults get coverage. Between 2013 and 2015, the uninsured rate fell from 45.4 percent to 16.5 percent.

Until Georgia lawmakers get behind the idea of Medicaid expansion, Stiger wonders: “How the hell am I supposed to take care of myself?”