Opinion: Expand Medicaid to help mothers

In a report published earlier this month by the Kansas Maternal Mortality Review Committee, the state’s maternal outcomes have worsened in recent years. Both pregnancy-related deaths and illnesses increased between 2016 and 2020.

According to the report, about two-thirds of pregnancy-related deaths were among women of color.

Just over a year ago, Kansas passed an expansion to postpartum coverage under KanCare, allowing mothers to be covered by the state’s Medicaid program for up to a year after giving birth. While it is too early to see the impact of this expansion on maternal outcomes in Kansas, a study of Texas’ expansion suggests there will be many benefits — women take advantage of mental health and substance abuse programs in addition to postpartum care under the state’s one-year extension.

However, the reality is that expanding postpartum coverage will have significantly less impact on Kansas mothers who live in maternity deserts.

A maternity desert is defined as a county with no hospital obstetrics care and no obstetricians or gynecologists.

According to a 2022 March of Dimes report, 48% of Kansas’ counties are maternity deserts and 24% of counties have low access to maternity care.

Kansas’ maternity deserts are expected to grow.

In an investigation by Wichita’s KWCH Factfinder 12 team earlier this year, over half of the state’s rural hospitals are at risk of closing. These hospitals provide critical care and services for people in their communities, including maternity care.

Of 104 rural hospitals, 60 are at risk of closing, including 29 facing immediate risk.

Rural hospitals are more vulnerable to financial pressures due to low occupancy rates, high levels of uncompensated care, competition from other hospitals and weak local economies.

But without these hospitals, there are very limited options for care in the state’s rural areas. Most patients would be forced to travel long distances to more populated counties, which is less than ideal in most circumstances and incredibly dangerous in emergency situations.

According to the KMMRC report, two-thirds of pregnancy-related deaths are among women on Medicaid or without insurance.

Full Medicaid expansion would go a long way in keeping hospitals open and expanding maternity care across rural Kansas.

The good news is Medicaid expansion is popular in Kansas.

According to the 2022 Kansas Speaks public opinion survey distributed by the Docking Institute of Public Affairs at Fort Hays State University, nearly 76% of Kansans support KanCare — Kansas’ Medicaid program — expansion. Support has increased about 11 points since 2015.

The bad news is there’s long been a lack of political will to pass full KanCare expansion in the Legislature, despite public support and federal funds to subsidize the expansion.

But legislators can be swayed by loud and participatory groups of citizens. In fact, it was grassroots advocacy that led to the expansion of postpartum coverage during the 2022 legislative session.

If citizens decide to advocate for Medicaid expansion, it would go a long way toward keeping rural hospitals open to provide care to their communities, including care to expecting and postpartum mothers.

— Alexandra Middlewood is the department chair of political science at Wichita State University.


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