Illinois and the United States face an ongoing crisis in which pregnant and postpartum people are dying. The crisis is magnified for Black pregnant and postpartum people, who are three times more likely to die during or after pregnancy than their white counterparts. The vast majority of pregnancy-related deaths – 83 percent – are preventable.
Illinois has been a leader in addressing this crisis nationally, most notably as the first state in the country to expand Medicaid coverage throughout the 12- month postpartum period (birthing people previously lost coverage just 60 days after delivery). This remarkable step has and will continue to save lives and demonstrates a commitment to providing comprehensive, continuous health insurance for the health of mothers and families. But lawmakers need to do more to ensure that people are their healthiest before pregnancy—expanding Healthy Illinois for All, a Medicaid look-alike program for undocumented adults, can do just that.
Moms and Babies, the state’s Medicaid program for pregnant and postpartum people, is available to all pregnant people with low income during and after pregnancy. But the health of pregnant people is inextricably linked to their health, and access to health care, before and between pregnancies. Waiting until someone is pregnant to provide reliable, comprehensive access to wellness care, management of chronic illness, behavioral health care and all of the other services that open up to people with insurance is putting providers, pregnant people, and their families at a disadvantage.
Take the example of Victoria from the Illinois Department of Public Health’s 2021 report on maternal mortality. A Black woman in her 30s, Victoria immigrated to the United States prior to becoming pregnant. She was insured and receiving regular care for lupus, up until just one month before she became pregnant, when she lost her insurance. Victoria experienced a worsening of lupus, a common experience for many pregnant people with chronic conditions, and died of sepsis while pregnant. The State highlights Victoria’s story to demonstrate the vital importance of consistent access to health insurance and health care for those who may become pregnant. The report asserts that “consistent insurance can facilitate continuity of care and better management of chronic medical conditions before and during pregnancy and help to prevent complications during pregnancy.”
Lawmakers now have the opportunity to provide that very consistency by expanding Healthy Illinois for All. The State led the way in expanding health coverage to undocumented children more than 20 years ago, and adults in the last three years, but a gap remains for those between 19 and 41. This, of course, being a time when many are becoming pregnant.
We need not speculate about the benefit of expanded health insurance for maternal outcomes, however. Earlier this year, a study published in Health Affairs demonstrated that the Affordable Care Act’s expansion of Medicaid for childless/non-pregnant adults improved maternal health outcomes and led to a reduction in postpartum hospitalization. Comparing hospital utilization data in states that did and did not expand Medicaid for this population, researchers found a 17 percent decrease in hospitalization for individuals in the first 60 days postpartum and a smaller reduction between 60 days and six-months postpartum. The authors conclude “expanded Medicaid may affect postpartum outcomes by increasing coverage and access to care before pregnancy” and say their findings suggest a need for “long-term continuous health care” among those who could become pregnant or have recently given birth.
Every person should have the right to become a parent if, when, and how they choose and to parent the children they do have in safe communities. We cannot meaningfully make this right a reality without even basic access to health insurance and health care for all Illinoisans across the lifespan. Lawmakers have the opportunity to stand with immigrant communities, improving health care for all, and address a serious factor driving the maternal mortality crisis by expanding Healthy Illinois for All. – Chi Chi Okwu
Chi Chi Okwu is the Executive Director at EverThrive Illinois, which works to ensure people from communities most impacted by injustice have the access, resources, health care, and choice to create and sustain healthy families on their own terms.