A young woman brought her baby for a well child check. A family physician who cared for her and her child, I casually asked, “When is your next appointment with me?”
“I can’t come in,” she said. “I’m not on Medicaid, and I can’t afford a visit.”
Her child qualified for Medicaid but, with lower income limits for parents, she was not eligible.
This encounter repeated itself over and over while I was in practice.
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An important report from NC Child, Strengthening Women’s Health: A Key to Reducing Infant Mortality and Eliminating Racial and Ethnic Disparities, links this situation to infant mortality – and the potential to decrease deaths among our most vulnerable infants by expanding Medicaid.
North Carolina has the eighth highest rate of deaths among infants under the age of one year in the country, worse than not only South Carolina and Tennessee, but also Croatia and Russia. Although infant mortality in our state has declined 40 percent over 20 years, it has stalled and the gap between African American and white babies has increased.
The mother’s health before conception makes a big contribution to a healthy pregnancy with a happy outcome. This is most likely to occur if the woman has access to contraception to healthily space pregnancies, treatment of chronic conditions, mental health care and tobacco and substance abuse counseling. The report notes 37 percent of women of reproductive age suffer from at least one chronic condition that is a pregnancy risk.
Yet one in five women of reproductive age in North Carolina is uninsured. Over half of them are in the coverage gap, earning too little to quality for subsidies for Affordable Care Act plans. And over half of these women lack any affordable health care.
If Medicaid were expanded in North Carolina as outlined by the ACA – and enacted by 31 other states – these women could get the care they need.
People need health care throughout their lives. Yet I found young women in my practice got a strange message. Health care coverage was available to them during pregnancy – after they were accepted by Medicaid; then not available after they delivered, available once more after they learned they were pregnant again and had waited again to be accepted. It was hard to persuade them that they needed consistent care when their experience was that it was only intermittently available.
Evidence shows expanding Medicaid would decrease mortality, reduce suffering, allow North Carolinians to get needed preventive care and treatment, as well as create jobs and boost our economy.
Now we can add to the list of benefits: improving the health of women of reproductive age with the potential of improving the survival and health of the next generation.
Dr. Jessica Schorr Saxe is chair of Health Care JusticeNC. Email: HCJusticeNC@gmail.com.