New report: Medicaid expansion would improve maternal health in Alabama

Medicaid expansion would improve women’s health and expand access to maternal health care across Alabama, a new Georgetown University Center for Children and Families (CCF) report found. Expansion also would help reduce racial disparities, improve infants’ health and strengthen rural health care access, the report found.

Nearly one in six Alabama women (15.9 percent) of reproductive age (18-44) lack health insurance, CCF found. That rate is significantly higher than the national average (11.7 percent). And uninsured rates are sharply higher among Hispanic (41.5 percent) and Native American (46.7 percent) women in Alabama. Medicaid expansion would help by ensuring health coverage for tens of thousands of Alabama women who cannot afford it.

Alabama policymakers last year extended the Medicaid postpartum coverage period. That extension ensured coverage for a full year after childbirth, up from the previous cutoff of just 60 days afterward. But much work remains to protect women’s health in the state, said Debbie Smith, Alabama Arise’s Cover Alabama campaign director.

“State leaders showed they’re willing to address Alabama’s maternal health crisis when they extended Medicaid postpartum coverage last year,” Smith said. “However, these findings show that this step alone is not enough to help mothers and families stay healthy. Alabama should take the next logical step to protect women’s health and expand Medicaid coverage for adults with low incomes. We urge Gov. Kay Ivey and legislators to make Alabama a better place for parents and babies by expanding Medicaid.”

Alabama had the nation’s third-worst maternal mortality rate between 2018 and 2020, the report found. The state’s rate (36.2 maternal deaths per 100,000 live births) was significantly higher than the national average (20.4 per 100,000) in those years.

Alabama’s infant mortality rate (7.2 infant deaths per 1,000 live births) also was much higher than the national average (5.4 per 1,000) in 2020. Black babies died at an even higher rate in Alabama that year (11.1 per 1,000 live births).

A decades-long decline in access to maternity and obstetric care in rural Alabama is compounding these statistics. Twenty-nine of Alabama’s 54 rural counties lost hospital obstetric care providers between 1980 and 2019, CCF found. These closures required women in these counties to travel farther to providers elsewhere. That, in turn, can reduce the timeliness of care and increase barriers for women with limited transportation options.

Medicaid expansion is associated with lower maternal and infant mortality rates, with the greatest benefits for Black women and infants. Expansion also promotes health improvements throughout pregnancy and into children’s early years, CCF found. In addition, Medicaid expansion would decrease the costs of uncompensated care significantly, allowing more rural hospitals and providers to remain open to continue treating pregnant Alabamians.

“Research shows that stable health coverage for women before, during and after pregnancy can save moms and babies’ lives,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. “Medicaid expansion is an essential investment in the health of Alabamians and builds a solid foundation for the state’s future.”