California's Maternal Deaths Dropped Without Health Care Expansion – A Tough Prospect In Texas

Feb 23, 2018

This is a final note to a three-part series on maternal deaths in Texas.

Some of you might have noticed our series on Texas’ maternal mortality crisis this week didn't address the possibility of expanding access to health care in Texas – or how expansion impacted California's crisis. There are some reasons for that.

We looked at California’s successful effort to reduce maternal mortality in the state, and how Texas could possibly replicate that model to save lives. When it’s come up in the past, public health advocates typically point to the fact that Texas has the highest rate and number of uninsured people in the country – many of who are, of course, women.

"Maternal mortality is a cascade effect that we see in Texas,” says Ted Fox, a retired hospital CEO and board member Texas Doctors for Social Responsibility. “It starts with the inability of people to get care.”

Women’s health care advocates have argued the rise in maternal deaths in Texas coincided with the state’s decision to remove Planned Parenthood – and other women’s health clinics who also provide abortions – from the Texas’ Women’s Health Program.

So here are some of the reasons experts in California didn’t point to health care access as the reason the state’s rate of maternal deaths dropped.

California’s rates dropped without a massive expansion of health care access

In 2013, California Gov. Jerry Brown California signed legislation expanding Medicaid to more low-income adults under the Affordable Care Act.

However, California started had started tackling its maternal mortality issues in 2006 – seven years before that expansion.

According to the California Department of Public Health, the state’s maternal mortality rate dropped from more than 15 deaths per 100,000 births to 7 deaths per 100,000 births in the years before the expansion

Elliott Main, medical director with the California Maternal Quality Care Collaborative, says there’s no data yet on how the Medicaid expansion affected the state’s maternal mortality rates.

“It’s too early to see the outcomes of that,” Main said, “but a lot of people are paying a lot of attention to that.”

When asked if he thinks the rates will have dropped further, he said, “We hope so.”

Regardless, Main says there are benefits to expanding health care, particularly to more women.

Currently, Texas kicks new mothers off of its Medicaid program two months after they give birth. Main says that means many women who recently had babies aren’t getting regular medical attention.

“The medical issues don’t end at six-weeks post-partum,” Main said.

Main also says, when addressing maternal mortality, health officials shouldn’t just focus on hospitals, labor and delivery. He says this is also about access to care for women who have medical issues before and after their pregnancy.

“You can’t expect them to do well for the few months of pregnancy if they have been… poorly cared for before their pregnancy,” he says.

Expanding access requires political will

Advocates face a hard battle in Texas, when it comes to expanding access to health care – particularly Medicaid. The Republican-controlled Legislature is ideologically opposed to the Affordable Care Act, which has funded Medicaid expansions in most states.

Fox says the fact state leaders have refused to expand Medicaid demonstrates “a lack of political will in Austin.” He says the decision to not provide more health care to low-income people has led to higher rates of illness, or morbidity, in Texas.

“We have people who can’t get health insurance,” he said. “And when you can’t get health insurance, you can’t get access to care. When you forego care, actual mortality and morbidity increases in the population.”

Below, you can read and listen to our entire three-part series on how California reduced maternal deaths – and how Texas could replicate that model.

Part 1: Like Texas, California Once Had A Maternal Mortality Crisis. Here's How The State Solved It.

Part 2: Here's How Texas Can Follow California's Lead In Reducing Maternal Deaths

Part 3: There's No Success Story Texas Can Follow To Stop Black Mothers From Dying