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Texas considers extending Medicaid access after birth to make having a baby safer


Abortion restrictions in Texas trained greater attention on the state's high maternal mortality rate. Now lawmakers are considering extending Medicaid access to make childbirth safer. Elena Rivera from member station KERA in Dallas explains.

ELENA RIVERA, BYLINE: Right now, Medicaid covers half of all births in Texas. Many rely on that coverage to access everything from doctor's appointments to prenatal vitamins. But the coverage ends two months after giving birth. Victoria Ferrell Ortiz applied for it after learning she was pregnant in 2017. She had just left a nonprofit job in Dallas and didn't have insurance.

VICTORIA FERRELL ORTIZ: It was a time of, like, a lot of learning and turnaround and pivoting for me because we weren't necessarily expecting that kind of life change.

RIVERA: Ferrell Ortiz says the coverage was sometimes confusing to use. She spent hours on the phone trying to find a doctor nearby.

FERRELL ORTIZ: 'Cause it took so much time. And then sometimes the representative that I would speak to wouldn't know the answer.

RIVERA: She was glad she was covered when she gave birth, but losing insurance when her baby was so young was stressful.

FERRELL ORTIZ: The two months window just puts more pressure on women to wrap up things in a messy, not necessarily beneficial way.

RIVERA: In Texas, most uninsured adults have few options. Unlike 39 other states, Texas didn't expand Medicaid, which means hundreds of thousands here make too much to qualify for Medicaid but not enough to afford other health insurance. Pregnancy Medicaid helps fill the gap temporarily. Close to half a million Texans are currently enrolled in the program. The majority are Hispanic and Latinx women between 19 and 29.

Kari White is a professor at UT Austin who studies reproductive health care in Texas. She says even those who qualify for pregnancy Medicaid have trouble using it.

KARI WHITE: What it looks like from a bird's-eye view is a big patchwork with some missing holes in the quilt.

RIVERA: White says many doctors and clinics won't accept pregnancy Medicaid or have long waits for appointments. But she thinks extending the coverage to a year after childbirth would help improve patients' health. White says it would be especially helpful for people with chronic diseases, like high blood pressure or diabetes.

WHITE: And when those health conditions become exacerbated, they can have very dangerous consequences for people, regardless of whether or not they get pregnant again.

RIVERA: About 20% of pregnancy-related deaths in Texas stem from chronic diseases. White says a lot of these deaths are preventable.

WHITE: They're trying to raise a new baby. They need to get back to work. And it makes it really difficult for them to do those things when they aren't able to get medical attention to see what's going on.

RIVERA: Black Texans are affected by these disparities at higher rates than other groups. They are twice as likely to die from a pregnancy-related cause than their white counterparts.

Diana Forester is with the advocacy group Texans Care for Children. She says a full year of postpartum coverage will make childbirth safer in Texas. And both Democrats and Republicans are listening.

DIANA FORESTER: I think we have the opportunity to get 12 months postpartum passed. I feel like the momentum is there.

RIVERA: Victoria Ferrell Ortiz says her pregnancy was one of the biggest changes her body went through. Her daughter Amelie will be 5 soon. But looking back, she wishes she had more time to address health concerns before her coverage ran out.

FERRELL ORTIZ: If I was able to talk to people of the legislature about extending coverage, I would say to do that. It's an investment in the people who are raising our future and completely worth it.

RIVERA: Texas lawmakers have until the end of the legislative session in May to make this change and find other ways to improve the health care that pregnant Texans get every year.

For NPR News, I'm Elena Rivera in Dallas. Transcript provided by NPR, Copyright NPR.

Elena Rivera