Biden Administration proposal addresses maternal mortality, underserved communities

The Biden-Harris Administration unveiled a series of new policy proposals last week that would require hospitals to implement initiatives to improve maternal health and support underserved communities.

The proposal introduces new approaches to maternal care, such as extending postpartum Medicaid coverage and implementing new hospital standards. These significant shifts in health care policy could have far-reaching effects on maternal health outcomes. The proposal comes at a time when threats to abortion care are at the forefront of national debates, with many states enacting restrictive laws that limit access to reproductive health services.

As journalists, we can help the public understand how these changes might impact them or their communities, as well as the potential long-term impacts of these policy changes. Here are some ways we can examine the policy proposals for our audiences:

Tucked in the plan are also other policies aimed to reduce health disparities within incarcerated people and indigenous communities, which are briefly highlighted below.

Key proposals outlined

Extending postpartum Medicaid coverage. For children under age 19 on Medicaid or CHIP (health insurance for low-income families), the policy ensures they stay covered for a full year at a time. This means less paperwork hassle and more consistent care for nearly 40 million children. According to the Kaiser Family Foundation, as of August 2022, approximately 37.8 million children were enrolled in Medicaid (including Medicaid expansion CHIP), with about half of those children in states with 12-month continuous eligibility and half in states without the policy. This extends coverage beyond the typical 60-day postpartum period, potentially improving access to care for new mothers.

Improving hospital standards, including for maternal care. The proposal outlines changes to how hospitals and surgery centers get paid for outpatient care. This adjustment could influence the range of services these facilities offer and their associated costs. Medicare spending reached $944 billion in 2022, accounting for 21% of total national health expenditures. Medicare covered 65 million people in 2022, with enrollment projected to reach 78 million by 2030 due to the aging population.

Also, starting in 2025, there's going to be a $2,000 cap on out-of-pocket costs for prescription drugs under Medicare Part D. This is due in part to the Inflation Reduction Act, which is President Biden's law to lower drug costs, and may benefit older adults who spend a lot on medications. This is significant given that in 2021, 1.3 million Part D enrollees without low-income subsidies had out-of-pocket spending above $2,000.

The proposal also introduces new requirements for obstetrical services, including requiring hospitals to invest in staffing and care delivery. The document doesn't detail what this looks like, but the goal is to ensure hospitals are better prepared to deliver emergency obstetrical services. This is crucial given that in 2021, the maternal mortality rate in the U.S. was 32.9 deaths per 100,000 live births, significantly higher than in other developed countries. Hospitals who don't follow the requirements could be removed from Medicaid and Medicare programs.

Health care for the formerly incarcerated. The proposal redefines "custody" to remove barriers that prevent formerly incarcerated individuals from enrolling in and maintaining Medicare coverage. This includes extending eligibility criteria for the special enrollment period to those on parole, probation or home detention. Contact advocacy groups focused on prison reform for perspectives on how these policies could address health disparities.

Supporting Indian Health Service (IHS) and tribal facilities. The outlined policy supports IHS and tribal facilities by increasing Medicare payments for critical, high-cost medications, including cancer drugs, in IHS and tribal hospital outpatient departments. This initiative supports the Cancer Moonshot goal of preventing cancer deaths and improving cancer care for underserved populations.

The comment period for the proposed rule is open until Sept. 9. To learn more, check out the full proposed rule and fact sheets on the Federal Register and CMS websites.

Additional resources

• Maternal and Child Health Tools and Resources - American Hospital Association.
• Government Maternal Health programs - US Health Resources and Services Administration.
• Biden Administration Blueprint for Addressing the Maternal Health Crisis - The White House.