Unanimous support on Senate committee for a year of postpartum health coverage
A broad group of Democrats, Republicans, medical experts, insurance representatives, the Catholic church and anti-abortion advocates voiced their support Wednesday for a bill that would extend Medicaid coverage for postpartum women in Wisconsin from 60 days to one year.
Co-authors Sen. Joan Ballweg (R-Markesan) and Rep. Donna Rozar (R-Marshfield) said during a Senate Insurance and Small Business committee hearing that the bill would help bring care for mothers up to speed with what newborns — who are automatically eligible for coverage throughout their first year — receive.
“Postpartum care — including recovery from childbirth, follow-up on pregnancy complications, management of chronic health conditions and addressing mental health concerns — is essential to increasing positive health outcomes for mothers and babies,” Ballweg told the committee.
Pregnant women with family incomes up to 300% of the federal poverty level currently qualify for extended Medicaid benefits for at least 60 days after they give birth. SB 110 would require the Wisconsin Department of Health Services to seek approval from the federal Department of Health and Human Services to extend that coverage to a year postpartum.
Proponents of the bill spoke about the challenges women can face before, during and after pregnancy and how the additional months of coverage could help prevent negative outcomes.
Annmae Minichiello, a UW Health pharmacist and a volunteer with the American Heart Association, said she wrongly assumed that she would have no complications during her first pregnancy because she was healthy and physically active. But her first pregnancy brought peripartum cardiomyopathy, a weakness of the heart muscle that begins during pregnancy.
“Initially, my body rejected the treatments I received. I could hardly believe what was happening. How could I go from running a triathlon to barely breathing while walking?” Minichiello said. “I started to believe I was gonna die leaving my daughter without a mother, and my husband without a wife. Miraculously the right prescription regimens stabilized my blood pressures, and several months later my heart functions had returned to normal.”
Minichiello said the circumstances took a significant toll on her mental health as she suffered post-traumatic stress disorder, dealt with anxiety and had difficulty bonding with her newborn. She said her heart has now fully recovered, five years later.
“While my pregnancy journey has a happy ending, many others do not,” Minichiello said, adding that access to health care could help save lives.
Women’s postpartum health has become a chief concern across the country. According to the Centers for Disease Control (CDC), around 700 women in the U.S. die from pregnancy-related complications each year.
Jasmine Zapata of the Wisconsin Department of Health Services said Wisconsin reviews about 50 to 60 maternal mortality deaths each year. Zapata said about 50% of the deaths reviewed by DHS are Medicaid patients. Around two-thirds of the deaths happen between 43 and 365 days postpartum and over 90% of those deaths are preventable.
“Some people would say, ‘Oh 50 — that’s not a big number,” Zapata said. “As a physician who has had to go into a room and tell a family that ‘your loved one is dead,’ and to have to hear the terror in their voice, their knees collapsing, that is not something I wish on anyone else and when you are in that situation, even one life is too many.”
The impact of the bill would be particularly significant for Black women and women of color in Wisconsin, said Zapata. According to DHS data, maternal mortality in Wisconsin from 2006-2010 was five times higher for Black women than white women.
Zapata said the reality gives her concern about raising her daughters in Wisconsin.
“As a mother who has birthed three children in this state, as a Black mother, I’m terrified sometimes even living here,” Zapata said. “When I think about my daughters, my two daughters, I really contemplate is Wisconsin the place that I want them as young Black women to grow up and have their own children? But we have a historic opportunity to change that all around.”
Proposals to extend the coverage haven’t progressed in recent years. Gov. Tony Evers included the proposal in his 2019-2021 and his 2021-2023 budget proposals. During the last budget cycle, the Republican-led Legislature opted to include a directive for the Wisconsin Department of Health Services to request a waiver to extend coverage to 90 days, rather than accept Evers’ proposal for a full year of coverage.
The waiver request to extend coverage to 90 days has been in limbo, according to Ballweg. She said she was surprised DHS hasn’t heard back about the waiver from the federal Centers for Medicare & Medicaid Services (CMS).
Evers has included another proposal for extended coverage for one year in his 2023-2025 executive budget.
If Wisconsin adopted the policy, it would join the majority of states that have already extended coverage. According to Kaiser Family Foundation’s Medicaid Postpartum Coverage Extension Tracker, 30 states have already adopted the expanded 12-month coverage, including Michigan, Minnesota, Illinois, Tennessee, Alabama and Florida. Eight other states are planning on implementing the coverage. Wisconsin is one of two states that have sought a limited waiver, rather than implementing the full expansion.
The renewed momentum behind the policy follows the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health, which sent decisions about abortion back to state lawmakers. No abortions have been performed in Wisconsin since the decision, due to the state’s 1849 felony abortion ban, which doesn’t include exceptions for rape or incest.
Opponents to abortion at the hearing spoke about how the bill could help support the women who aren’t having abortions.
“I am proudly pro-life and this should be part of a pro-life package where we take care of the babies that we don’t want to be aborted,” Rozar said. In her prepared testimony, she also said that with the overturn of Roe v. Wade, she is “thankful that more children will be born, even under challenging circumstances” and that she believes “we should support those children by supporting their mothers.”
Matt Sande, legislative director of Pro-Life Wisconsin, said extending Medicaid coverage is “good public policy.”
“In a post-Roe nation, Wisconsin is presently a safe haven for mothers and their preborn children,” Sande said. “It is vitally important that we provide robust public and private support for pregnant mothers.”
Republicans and Democrats on the committee were in agreement that the bill would be positive.
Sen. Mary Felzkowski (R-Irma), the chair of the committee, said she strongly supports the bill. “We a lot of times make the mistake of thinking that pregnancy is easy, to just have a baby and life is good afterwards,” Felzkowski said. “But there’s a lot of things that can happen to people.”
“I surely hope that we can get this across the finish line and get it signed into law,” Sen. Brad Pfaff (D-Onalaska) said. “This is an issue that we should address. This is an issue that’s bipartisan that impacts people in rural and urban areas, and impacts people, regardless of their demographics or their socio-economic background.”
The cost of the postpartum coverage extension could depend on whether Wisconsin adopts federal Medicaid expansion, which is a central point of Evers’ proposed budget.
Wisconsin remains one of 11 states that have not chosen to take the Medicaid expansion, and according to the DHS website, Wisconsin would get enhanced federal funds through the Medicaid expansion, which would offset costs for things like the postpartum coverage expansion.
H.J. Waukau, DHS legislative director, said the postpartum coverage expansion would cost $21.4 million without the Medicaid expansion, which includes $8.4 million the state’s general purpose revenue. He said with the Medicaid expansion it would cost $17.4 million, including $6 million in general purpose revenue.
Sen. Lena Taylor (D-Milwaukee) pointed out that no one at the hearing registered or testified against the bill. Despite this, Taylor said there could still be challenges to making the policy law, referring to the uncertainty around how the Assembly might handle the bill.
“When you have a bill, that has everything, from the pro-life groups, to the Catholic Church, to organizations to the administration, literally, bipartisan legislators all across it, You would think it would be easy, right?” Taylor asked. “It’s still not going to be an easy time.”