“I think it’s completely unacceptable for the No. 1 state in the nation in which to do business to have one of the highest maternal mortality rates of any state in the country,” Ralston, R-Blue Ridge, told reporters in the state Capitol.
The U.S.' maternal mortality rate is among the highest in the developed world, and Georgia has consistently ranked among the worst of U.S. states for maternal deaths. About two-thirds of those fatalities in Georgia happen in the weeks and months after mothers give birth, according to a state study, and African Americans, rural residents and women over 35 are particularly vulnerable.
Currently, pregnant women in Georgia households that earn less than 200% of the federal poverty level — about $34,000 for a family of two and $52,000 for four — are eligible for Medicaid, which covers doctors’ visits, prescription drugs and hospital services, including labor and delivery. But that ends two months after they give birth.
That's created a coverage cliff for women who otherwise cannot afford insurance. In the weeks after giving birth, many race to take care of pressing medical procedures while they still have Medicaid and often forgo visits to the doctor after their coverage expires.
A bipartisan state study committee tasked with examining the crisis found that 60% of Georgia's maternal deaths between 2012 and 2014 were preventable, and it recommended the Legislature extend Medicaid for a year after low-income women give birth.
But in a tight budget climate in which Gov. Brian Kemp has directed legislators to cut spending by 6% in fiscal 2021, the price tag has proved to be a big ask, and House Health and Human Services Committee Chairwoman Sharon Cooper in recent weeks floated a four-month Medicaid extension as a more wallet-friendly alternative.
“This is a step in the right way, and it gives us time to encourage new mothers (about) how important those postpartum visits are,” said Cooper, R-Marietta, a former nurse who led the state study committee.
Ralston estimated the waiver would cost the state roughly $19 million a year. He brushed away a question about why his chamber wasn’t seeking one year of Medicaid funding for new moms.
“I reject the view that if you can’t add everybody right now we shouldn’t add anybody right now,” he said.
Roughly half of all births in Georgia are covered by Medicaid.
While data is spotty, one state study estimated new mothers in Georgia were 52% more likely to die in the first year after giving birth than the national average. A woman's physical health prior to pregnancy plays a major role in mortality rates, as does access to reliable health care and transportation before and after a baby is born. A growing body of research has also suggested the stress associated with being a black woman is another factor, and African Americans in Georgia are three to four times more likely to die when they become mothers than white women.
HB 1114 would also clear the way for roughly $250,000 a year in funding for lactation care services for new mothers.
Ralson said he has not discussed the legislation with Kemp or Senate leaders, although Senate President Pro Tempore Butch Miller, R-Gainesville, later said he and his colleagues are “open to the idea of extending the time frame for eligible women to receive additional medical treatment, post-delivery.”
“The right to life, which we’ve fought so hard to protect, means nothing if we don’t look out for the courageous women who bring life to term,” Miller said.
Kemp spokesman Cody Hall called Georgia’s maternal mortality rate “alarming” and said the governor’s office “hope(s) to learn more about the House’s proposal in the coming days.”
“The governor looks forward to working with Chairwoman Cooper, members of the General Assembly and other stakeholders to address this critical issue,” Hall said.
Elise Blasingame, the executive director of the Healthy Mothers, Healthy Babies Coalition of Georgia, said her organization was “very thankful” for the legislation, which she said “would undoubtedly save countless lives.”
“This move will save money for our hospitals, especially those in underresourced areas, that typically end up caring for women in crisis during the postpartum period after their Medicaid has lapsed,” Blasingame said.
Staff writer Greg Bluestein contributed to this article.
WHY IT MATTERS
The Atlanta Journal-Constitution traveled last month to Jesup in southeast Georgia to chronicle how the state's maternal mortality crisis is playing out on the ground. New mothers shared stories about their complications — both physical and financial — during and after childbirth, and OB-GYN Jeffrey Harris discussed the interlocking factors that make delivering care to his patients so complicated. Among those factors are Georgia's rural hospital crisis, the national OB-GYN shortage, and barriers to longer-term health care and transportation options.