Deaths of African-American babies declined most quickly in states that expanded Medicaid coverage, researchers have found.
North Carolina isn’t one of those states.
More than 15% of North Carolina women ages 19-44 don’t have health insurance, 10th most among states, according to the United Health Foundation. North Carolina is one of 14 states that has not adopted Medicaid expansion as allowed by the Obama-era Affordable Care Act.
States that expanded Medicaid, which allowed more low-income adults to have health insurance, also had greater overall declines in infant death rates, said a 2018 study published in the American Journal of Public Health. Those improved rates were driven by declines in black babies’ deaths.
Democratic Gov. Roy Cooper has made Medicaid expansion one of the central goals of his administration and used the narrowing of the differences in infant deaths by race as one of the rationales for insuring more adults.
The state House last year considered a proposal, House Bill 655, which would have allowed more low-income adults to qualify for health insurance if they work and pay premiums. The state Senate has refused to consider any plan that looks like Medicaid expansion, saying it would be too expensive.
Other proposals could come forward. Republican state Sen. Jim Burgin of Angier wants to drastically reduce the rate of black infant deaths, and says he has ideas that don’t involve expanding Medicaid.
Sen. Ralph Hise, a Republican from Spruce Pine who opposes Medicaid expansion, said the study was not proof that getting more women on government health insurance lowered infant death rates or narrowed the racial gap in infant deaths.
“They’re showing a correlation, they’re not showing a causality,” Hise said.
In 2018, North Carolina’s death rate for all babies dropped to its lowest level in decades, and the difference between black and white death rates narrowed slightly. But black babies were 2.44 times more likely to die in 2018 than white infants, a wider gap than 2.33 times in 1999. Information for 2019 is not yet available.
Health before, after pregnancy matters
Joan Alker, executive director of the Center for Children and Families at Georgetown University, said the conclusions about insurance improving infant health make sense.
As it stands in North Carolina, low-income women who don’t normally qualify for Medicaid can use it if they become pregnant, to cover conditions related to their pregnancy. The coverage ends two months after they give birth, about enough time to schedule a postpartum visit.
Jessica Murrell Berryman enrolled in Medicaid when she was pregnant with her first child. She had just graduated from N.C. A&T in Greensboro and couldn’t find full-time work as the economy began to spiral into recession.
Berryman, who lives in Durham with her husband and three children, went on to start her own business and get private insurance. She now works for a behavioral health hospital.
She said allowing new mothers to stay on Medicaid for more than two months is important to diagnosing and treating postpartum depression and other illnesses that may influence the quality of care mothers give their children.
Berryman, a member of the steering committee for MomsRising, did not have postpartum depression after her first child but has come to appreciate, through her job, the importance of timely mental health treatment.
“With two months of Medicaid, if I have postpartum, how am I going to get a partial hospitalization program that I can be involved in, or an intensive outpatient program, or how can I get therapy or medication management if my Medicaid runs out?” she said. “That means I can’t be an effective mom.”
Being healthy before becoming pregnant is important for women and their children, Alker said. Since 2018 more evidence has piled up about the benefits of health insurance for women of reproductive age in research papers published in peer-reviewed journals, Alker said.
Best practices are “very clear that you need to be covering women before they are pregnant, while they’re pregnant and after they’re pregnant,’ she said.
Lack of medical coverage means that women with high blood pressure or depression don’t get those conditions under control before they become pregnant, she said.
“If you don’t have health insurance, you’re already starting 10 steps back from somebody who does,” she said.
People focused on improving black babies’ chances of living say workplace protections and benefits are also important.
The group MomsRising wants the state to adopt paid family and medical leave, paid sick days, and laws that would guarantee that employers make workplace accommodations for pregnant women and set up rooms other than bathrooms where mothers can pump breast milk.
Eight states and Washington, D.C., have adopted paid family-leave laws, according to the Bipartisan Policy Center, while 11 states and Washington, D.C. have paid sick-leave laws, according to the National Conference of State Legislatures.
A 2019 study out of Duke University’s Center for Child and Family Policy examined two possibilities for insurance in North Carolina that would have employees pay into a fund that they would draw from to partially replace their pay while on family leave. Offering parents 12 weeks of leave at 80% of their salaries would save 26 infants’ lives each year, the report said.
Paid family leave would guarantee parents time at home with their newborns, and time for mothers to establish breastfeeding, said Beth Messersmith of MomsRising’s North Carolina chapter. Earned sick leave would mean that parents wouldn’t have to sacrifice pay to care for sick children or take them to the doctor, she said.
In North Carolina, House bills for paid sick leave and family and medical leave insurance did not get hearings. Those bills drew all Democratic sponsors.
Burgin signed on to a Senate bill that would have required businesses with at least 15 employees to make accommodations for pregnant workers, such as temporarily assigning them to less hazardous jobs or allowing them more bathroom breaks.
Similar laws have passed in other states with bipartisan support. South Carolina passed a similar law last year. In North Carolina, Senate Bill 558, which had a Republican and two Democrats as primary sponsors, did not get a hearing.
A Republican alternative?
Burgin, an insurance company owner who is in his first Senate term, is a member of the Senate Health Committee and the state Child Fatality Task Force, a group that makes recommendations to the legislature.
Burgin said in an interview he learned that death rates for black babies are twice as high as they are for white babies during a state Department of Health and Human Services committee presentation. “I want to know what we can do to change that,” he said. “I don’t think that’s a good record, and I’m not at all happy with it.”
Burgin says he wants to lower the death rate for black babies by five points over five years.
“I think that’s something we can do,” he said.
Burgin said he does not want to expand Medicaid because of questions about the expense and how many more people would enroll.
“As a business guy, I always want to calculate costs,” he said.
He does, however, want new mothers who use Medicaid to cover their pregnancy care to stay insured longer than two months after they give birth. Burgin wants to extend the time to six months as a trial, and then offer it to women who are in community college working toward degrees or certificates that will make them self sufficient.
“Most people want to be able to take care of themselves and their children,” he said. “If we give them an avenue to get to where they’re self sufficient, we’ve done a good thing.”
This article is published through the N.C. News Collaborative, a partnership of BH Media, Gannett and McClatchy newspapers in North Carolina that aims to better inform readers throughout the state.