Health Insurance

Republican states trying to ban abortion expand health benefits for new mothers | Abortion

A number of Republican-led states that are moving to ban abortion are, at the same time, extending health insurance benefits to new mothers, professing to support “women in crisis”.

As the US supreme court prepares to rule on national abortion rights, many Republican states are seeking severe abortion bans that would force many women to carry pregnancies to term, likely worsening the US maternal mortality crisis.

Some of those same lawmakers are now passing bills that extend Medicaid benefits to low-income mothers, typically for one year after they give birth rather than the current two months.

Arizona, Florida, Tennessee and Texas have all extended health benefits for low-income mothers in recent months, and Alabama and Georgia have both moved to implement such extensions, according to the Kaiser Family Foundation. All have also sought to impose severe abortion restrictions or bans.

Although expanding pregnancy-related health coverage is “a win in many ways”, it does not counteract the fact that abortion bans “would certainly lead to higher risks for maternal morbidity or mortality,” said Sarah Blake, an associate professor of health policy at Emory University in Georgia.

Blake said Georgia lawmakers are in “Jekyll and Hyde mode”. Even as advocates for maternal health, herself included, are “very happy” for the extension, she said, “we know the state is very against women and their access to full scope reproductive health services”.

Changes to postpartum benefits come as the supreme court is expected to rule in the coming days on a critical abortion rights case, Dobbs v Jackson Women’s Health Organization. A leaked draft opinion showed conservative justices are on the verge of ending federal abortion protections. If that happened, 26 states would be certain or likely to ban abortion.

“It shows you how [Republicans] are not operating in good faith,” said Loretta Ross, an associate professor at Smith College in Georgia and a reproductive justice activist. “If they really cared about maternal mortality they’d reduce the causes of maternal mortality – and it goes way beyond Medicaid expansion.”

State legislators in both Democrat- and Republican-led states have made changes to Medicaid, a federal and state partnership that provides health insurance for the poor and disabled, to take advantage of a provision of federal pandemic aid which streamlined postpartum benefit changes.

However, the most dramatic effects would be in Republican-led states, where lawmakers have long refused to expand the program to more low-income people.

The refusal is a legacy of Obamacare debates. Around the time the Affordable Care Act, better known as Obamacare, Republicans sued to stop the expansion of Medicaid. They succeeded in the supreme court, and each state was forced to adopt Medicaid expansion individually.

A dozen states, mostly in the US south, still refuse to do so, even though the federal government would pay 90% of the costs of expanding the program.

Expanding Medicaid only to postpartum women appears to be a way for Republican-led states to champion their aid to a sympathetic group, even as they oppose broader Medicaid expansion and ban abortion, said Ross.

In Texas, for example – a state where one-quarter of women of reproductive age lack health insurance, the highest rate in the nation, and which is among the 10 worst states for maternal mortality – lawmakers recently expanded Medicaid to pregnant patients for six months after giving birth, instead of two.

A single adult supporting two children cannot earn more than $2,760 a year and qualify for Medicaid – unless they are pregnant, in which case they can earn up to $45,600 a year and qualify. However, the exemption previously lasted just 60 days after birth – the federal minimum – after which most people become uninsured once again.

The expansion to six months is welcome but insufficient, said Erika Ramirez, director of policy and advocacy for the Texas Women’s Healthcare Coalition: “We got six, which is better than nothing … [But] over and over, [the] top recommendation [from maternal health experts] has been for women to get postpartum care for a full 12 months.”

When the legislation was signed, Texas state senator Lois Kolkhorst, who sponsored it, described the Medicaid extension as a “bipartisan effort to help keep Texas moms healthy and provide the care needed to avoid preventable deaths and illnesses” .

Yet just two days before the bill passed in the Senate, Kolkhorst and her Republican colleagues passed a total abortion ban, which is expected to go into effect immediately if the US supreme court ends federal abortion protections. It is one of 26 abortion restrictions Kolkhorst voted for in her 11-year career as a legislator.

A similar effort to simultaneously extend Medicaid to pregnant women and ban abortion is under way in Alabama. There, one of the most vocal proponents of expansion is Republican state representative Debbie Wood, who also opposes abortion in nearly all circumstances, including rape and incest.

Kolkhorst could not be reached for comment and Wood did not respond to requests for an interview.

In Tennessee, the Republican governor, Bill Lee, directly connected the state’s postpartum Medicaid expansion and abortion. At a press conference in May, he spoke about Tennessee’s “trigger” ban, a law that will allow the state to immediately ban abortion if the supreme court ends federal protections.

“The lives of unborn children – it’s very important that we protect the lives of them,” he said, adding: “It’s also important that we recognize that women in crisis need support and assistance through this process. For example, that’s why we’ve expanded our postpartum coverage for women in TennCare.”

“This kind of strategy pits needy people against each other,” said Ross. “We’re supposed to advocate for postpartum women to get Medicaid, and screw everybody else who needs it? It’s a classic divide and conquer strategy.”

Links: Mark Shields’ death; universal health insurance; free speech

Political columnist Mark Shields died last week. There have been many tributes, all of which focused not only on his sharp commentary but also on what a decent person he was, and the fact that he was interested in, not appalled by, encounters with people who saw the world through different lenses from the ones he used. That is to say, he was an intellectual liberal as well as a political one. Two years ago, when he retired, his sparring partner on PBS's "NewsHour," David Brooks, wrote a lovely encomium.

There is nothing liberal about billionaire libertarian Peter Thiel, whom The Washington Post's Elizabeth Dwoskin profiled in Sunday's June 19 paper. I knew some but not all of this, and was especially intrigued by the title of a biography of Thiel: The Contrarian. Huh? There is nothing contrarian about this ideologue. That is what is so frightening about ideologues: Their ideological framework levels all of life's complexities. In their framework, no one hits a bump in the road, and it is those bumps that keep us humane. He is a 21st-century Ayn Rand with gobs of money. How boring.

In The Guardian, a report on the cost of not having universal health insurance: A new study indicates that the lack of such universal coverage in the United States resulted in an additional 338,000 lives lost during the pandemic and an additional $105 billion in health care costs. So, the next time someone says we can't afford universal health insurance, point out that we can't afford what we have, morally or financially.

At The New York Times, Coral Davenport takes a thorough and bracing look at the potential danger to environmental protections, and other necessary government functions, posed by a forthcoming Supreme Court decision in the case West Virginia v. Environmental Protection Agency. In this histrionic age, it is best to avoid the temptation to overstate the stakes in our various political and cultural battles. In this instance, to paraphrase a famous orator, extremism in the defense of common sense is no vice.

Politico looks at the challenges of changing newsroom cultures with a focus on the leadership of Sally Buzbee at The Washington Post, where she replaced Marty Baron in 2021. There is no way for democracy to function without a free press, and there are multiple dangers facing a free press today — some ideological, some financial, some cultural.

Relatedly, at The Atlantic, Conor Friedersdorf looks at the recent struggle at Georgetown University Law School over the limits of free speech. Newly hired Ilya Shapiro tweeted something that was undeniably stupid and offensive. He apologized, was suspended and the university investigated the matter. Shapiro ended up resigning but he also objected to the investigation by campus bureaucrats. The case raises serious issues about the direction of higher education. As health-law scholar Gregg Bloche told Friedersdorf: "Fear of career-ruining responses to words that offend is chilling classroom discussions, faculty scholarship, and conversation among colleagues."

At Chicago Catholic, Cardinal Blase Cupich offers some advice about preaching on the Trinity, and he cites the book The Vision of Catholic Social Thought: The Virtue of Solidarity and the Praxis of Human Rights, by St. John's University moral theologian Meghan Clark. At a time when too many reduce religion to ethics, it is wonderful to highlight the work of a theologian who recognizes the ways in which are dogmatic truths ground our ethical teachings, and even more when that work gets noticed by a bishop! I reviewed Clark's wonderful book here.

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Millions could lose health coverage if premium subsidies expire later this year, officials say

Absent Congressional action, many consumers will see health-coverage costs skyrocket next year, Biden administration officials warned Wednesday. 

The American Rescue Plan, signed into law in March 2021, temporarily expanded premium tax credits available to consumers signing up for health coverage through the Affordable Care Act marketplaces. Those expanded tax credits are set to expire at the end of this year, and extending them would require Congressional legislation. 

“Time is of the essence,” Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, said on a call with reporters Wednesday. As this fall’s open enrollment for 2023 marketplace coverage draws near, “we want to make sure that people know the subsidies will be in place,” she said. 

A record 14.5 million people signed up for coverage through the marketplaces during the open enrollment period that ended in January. The average monthly 2022 premium for enrollees was $111. Without the additional tax credits provided by the American Rescue Plan, that average monthly cost would have been 53% higher, according to the Department of Health and Human Services. 

If Congress does not act, more than 10 million people will see their premium tax credits reduced or lose them entirely, according to federal estimates, and about 3 million people could lose their health insurance. 

If lawmakers were to act by midsummer, marketplaces and insurers would have time to prepare for the 2023 open enrollment period, which starts in November, according to a recent report from the Urban Institute. The process of setting rates for 2023 plans has already begun.   

Congressional action later in the year could generate confusion as people are signing up for 2023 coverage, Brooks-LaSure said. “Of course we will pivot as quickly as we need to,” she said. But if action comes in the middle of open enrollment, it “would be so difficult for people to understand what was happening.” 

In addition to boosting premium tax credits for people who were previously eligible for subsidies, the American Rescue Plan expanded eligibility to people who were previously ineligible because their income was greater than 400% of the federal poverty level. An additional 2.8 million consumers received premium tax credits in 2022, compared with 2021, according to federal data. 

Without the American Rescue Plan’s enhanced premium tax credits, the average monthly 2022 premium in some states would have been roughly double what it is now. Among states that use the federal marketplace platform, the average 2022 monthly premium in Wyoming would have been 132% higher, according to federal data, while South Dakota average premiums would have been 95% higher.