It has been two years since I wrote on women’s healthcare and three important topics impacting women; clinical trials done without women participants, a failing birth control device – Essure, and maternal healthcare. The Health Affairs article is suggesting Medicare for all Maternal Care as an improvement to lacking healthcare for all women. Improving the availability of maternal healthcare for women is very much needed. As I wrote in A Woman’s Right to Safe Healthcare Outcomes; there is also a need for improving the care. There are too many symptoms being missed or ignored for the mother before, during, and after the birthing of a child.
Medicare is fee for service care. Medicare determines what will be paid. Those are the good parts. Dr. Donald Berwick claimed 30% of Medicare expenditures for care was waste and doctors knew it. However, Medicare for all Maternity is an important step forward which will level the field of care for “all” women.
A Bit of History
EMTALA or the “Emergency Medical Treatment and Active Labor Act” passed Congress in 1986. Its purpose was to require hospitals to provide emergency care for everyone crossing hospital thresholds regardless of the ability to pay. It also provides a means to pay hospitals for those patients who could not afford to pay. With the passing of the PPACA, each person was to be insured in one form (Commercial Insurance) or another (Medicaid/Medicare). The Medicaid Expansion mandate for states fell by the wayside with the Roberts Court ruling. Going with it was the federal government reimbursing hospitals.
Within the EMTALA, Congress was establishing, delivering a baby was an exceptional occurrence with inherent risks, and in such cases, delivery needed to be covered. Unfortunately, universal coverage for pregnancy was never been achieved with the passage of this bill. Although not having insurance at the time of delivery is not common, more than one in five people lack insurance either in the month just before pregnancy, during pregnancy, or in the postpartum period. With that being said, there was no provision made before or after delivery other than Medicaid and Medicaid will only cover 2 months of postpartum care.
The EMTALA is part of the Consolidated Omnibus Budget Reconciliation Act of 1985 or COBRA. Mitch McConnell (elected to the Senate in 1984), passed the bill with a 96-0 vote when bipartisanship was in vogue. President Ronald Reagan signed the bill on April 7, 1986.
Joe Biden’s American Rescue Plan passed without Republican votes. Within the American Rescue plan are provisions providing states the option to extend postpartum Medicaid coverage from 60 to 365 days. The ARP had unanimous support in the House as a stand-alone bill. While in the Senate, the support was not so strong and this time McConnell voted against healthcare for pregnant women. Also and as you may or not know, Republicans are attempting to use the funding for the American Rescue Plan to fund the proposed Infrastructure Plan.
Why is this so important?