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Report: Babies Are More Likely to Die in States That Didn't Expand Medicaid

Infant mortality rates have dropped in expansion states and risen in nonexpansion states.

A baby sucking its thumb.
(AP/Timothy D. Easley)
Last Updated May 28, 2019 at 12:03 p.m. ET



  • The United States has some of the highest infant and maternal mortality rates in the developed world.
  • Infant mortality rates dropped in expansion states and rose in nonexpansion states.
  • 14 states have not expanded Medicaid.
As the country grapples with increasing rates of maternal mortality, a new study from the Georgetown University Center of Health Policy found that one of the biggest things a state can do for the health of new mothers and babies is to expand Medicaid.

The United States is the only developed country where the maternal mortality rate has increased, doubling over the past two decades. Though the rate of infant mortality has declined 15 percent in the past decade, the United States still has one of the highest in the developed world -- more than double that of Japan and Sweden.

Under the Affordable Care Act, states can make more low-income people eligible for Medicaid, expanding eligibility to people who make less than $30,000 for a family of three, or 138 percent of the federal poverty line. The federal government picks up 90 percent of the costs.

Fourteen states have not expanded Medicaid, and the result can be deadly: States that expanded Medicaid saw a reduction in infant mortality -- from 5.9 to 5.6 deaths per 100,000, while the rate slighty rose in nonexpansion states -- from 6.4 to 6.5 deaths per 100,000.

The study comes at a time when a wave of conservative states is passing unprecedented abortion restrictions, which supporters say are meant to protect the lives of the unborn. Out of the nine states that have passed an abortion ban this year, five declined to expand Medicaid. In Alabama, which voted to outlaw abortion except if a mother’s life is in danger, a single parent of two children can’t qualify for Medicaid if she earns more than $320 a month.

Medicaid expansion was also found to decrease maternal mortality. According to the study, Medicaid expansion led to 1.6 fewer deaths per 100,000 women. 

Black women are three to four times more likely to die because of childbirth complications. They're also almost twice as likely to live in nonexpansion states. The uninsured rate of nonelderly African-American women is 14 percent in states that haven’t expanded Medicaid but only 8 percent in expansion states. Of the 12 states with the highest percent of African-American residents, seven declined to expand. 

Some of the holdout states are currently considering expanding Medicaid -- but on their own terms. For example, the Georgia Legislature passed a bill this session that allows GOP Gov. Brian Kemp to ask the Trump administration for a waiver from some Medicaid rules. Some states have added work requirements -- which have been struck down in federal courts -- while others have added time limits and other eligibility requirements. Although fewer people are typically eligible for Medicaid when states customize their expansion, experts say expanding Medicaid to women for a full year after they've given birth could reduce maternal and infant mortality.

Federal law only requires Medicaid to cover pregnant women 60 days after they give birth. The 60 day cut-off disrupts care and causes “existing health conditions to become more serious and more difficult and expensive to treat,” the study concludes.

But Adam Searing, the study's author, cautions: "Expansion is not a be all, end all. Not having good facilities, having a churn in coverage, not having coordinated care” are all factors that could drive up maternal and infant mortality.

*CORRECTION: An earlier version of this story included errors about Louisiana's infant and maternal mortality rates. The numbers were from 2014 to 2015, before the state expanded Medicaid, not from 2016 to 2018.

Mattie covers all things health for Governing.

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