Last week, the Black Mammas Matter Alliance hosted a packed briefing in the House of Representatives highlighting the poor maternal health outcomes impacting black women, including maternal mortality and infant deaths. These poor rates are present among black women of all socio-economic and educational levels, with black women being 3 to 4 times more likely to die from pregnancy-related complications than white women, and twice as likely to suffer from severe maternal morbidity (SMM). Despite the startling statistics, at the same time as the briefing, a group of 13 white men across the Capitol in the Senate were busy drafting a bill in secret to dismantle access to critical care that could help reverse these disparities. The Senate’s ACA repeal bill is rumored to be based largely upon the House-passed ACA repeal bill, the American Health Care Act (AHCA)—which would repeal the groundbreaking Affordable Care Act (ACA) and eliminate the health coverage needed for black women to address maternal health disparities.
NWLC research found that, prior to the ACA, only 12 percent of the most popular plans on the individual health insurance market offered maternity coverage. This left women who did not have insurance that covered maternity services shouldering the costs of maternity services, which range from an average of $32,093 for vaginal births to $51,125 for caesarian births covered by insurance. That’s a high price to pay, particularly for low-income women and women in low-wage employment who were more likely pre-ACA to forego needed prenatal care. For black women impacted by poor maternal health outcomes, lack of access to maternity care can have profound effects, including maternal or infant deaths.
That’s why it is imperative to preserve the ACA’s protections, like its requirement that plans cover a set of 10 essential health benefits (EHB), including maternity care, to ensure that women have access to the care that they need. Pregnant black women also suffer from other conditions, such as pre- and post-partum depression, so the EHB’s coverage of mental health services is also critical. However, the AHCA would eliminate this requirement—leaving it up to states to decide whether or not to provide these vital services. If past is prologue, we only need to look at the health market pre-ACA to know that many insurers will opt to not cover maternity care and other services that are essential to improving black maternal health outcomes.
Compounding the loss of maternity coverage—black women with pre-existing conditions like endometriosis could face difficulty in obtaining insurance coverage—particularly since the AHCA allows health insurers in certain states to take health status into account in setting insurance policy prices. This could result in insurers offering poor coverage that does not meet black women’s health needs and would force women with pre-existing conditions to pay high prices for needed coverage. This would return us all to a pre-ACA world where simply being a woman was considered a pre-existing condition.
Black women could also see their access to birth control jeopardized, including by an impending Trump Administration rule leaked through media reports that would allow virtually anyone, such as any employer, health insurer, or school to deny coverage of contraception due to religious or moral reasons. This would be devastating for black women as birth control is instrumental in treating a variety of menstrual disorders prevalent among black women, such as uterine fibroids. Access to birth control is also threatened through proposed cuts to the Medicaid program, which provides family planning services, as well as efforts to bar Medicaid funding to Planned Parenthood clinics that provide vital care and screenings.
We must address the alarmingly poor maternal health outcomes impacting black women, but we cannot do that if an ACA repeal bill is signed into law that strips coverage for maternity care and other needed services, like preventive care. While, we must acknowledge that black maternal health is not simply a matter of health coverage or access, but is also informed by racism, sexism, and social inequalities—access to needed health care and coverage are essential to helping to address black maternal health outcomes. As the ACA repeal bill advances in the Senate, we must continue to sound the alarm that the very lives of black women should not be up for political negotiation.