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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Maternal mortality rates rose during the pandemic

Analysis by

with research by McKenzie Beard

March 17, 2023 at 8:03 a.m. EDT
The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Today’s edition: Sanofi becomes the last major insulin manufacturer to announce price cuts. North Dakota’s Supreme Court keeps the state’s near-total abortion ban paused for now. But first … 

U.S. maternal mortality rates climbed nearly 40 percent during the pandemic

The nation’s maternal mortality rate rose significantly amid the pandemic, alarming lawmakers and experts who have closely tracked the issue.

But on Capitol Hill, the big question is whether policies, even bipartisan ones, aimed at moving the needle can pass in a divided Congress. Lawmakers championing maternal health notched some wins in recents bills to fund the government and are preparing another push for measures left on the cutting-room floor. 

Rep. Robin Kelly (D-Ill.), who co-chairs the House Maternity Care Caucus, is planning in the next few weeks to introduce a new version of the Momma’s Act, which includes policies like authorizing a national protocol for best practices to save mothers’ lives and promoting workforce diversity among maternal care providers. Meanwhile, the major advocacy group March of Dimes is planning to urge lawmakers to do more at meetings on Capitol Hill during its advocacy summit this month. 

This comes as the rate of Americans dying during pregnancy or the 42 days after increased by nearly 40 percent in 2021 compared with a year earlier — the third consecutive year the nation’s maternal mortality rate has gone up, according to federal data released yesterday. The number of deaths rose to 1,205 in 2021, up from 861 in 2020.

  • “Looking at the CDC numbers — and hoping that our congressional members are definitely paying attention — I think this allows us to open up a conversation [that] this is real,” said Stacey Y. Brayboy, the senior vice president of public policy and government affairs at March of Dimes. “It’s really having an impact on the country, that we’re losing women. Women are dying from pregnancy-related issues and that number continues to grow.”

The Post’s Lena H. Sun:

The details

We should note maternal mortality rates in the U.S. – and indeed in most of the world – remain far lower now than a century ago, when about 800 women died out of every 100,000 births.

But it’s still a problem, and the United States has long been criticized for having a worse maternal death rate than other high-income countries. And there are racial disparities; the mortality rate for Black women in 2021 roughly 2.6 times higher than the rate for White women.

In 2019, Rep. Lauren Underwood (D-Ill.), a nurse and former HHS official, co-founded the Black Maternal Health Caucus, which has been pushing to pass a package of bills known as the Momnibus. In addition, the bipartisan leaders of the Maternity Care Caucus — Kelly, along with Rep. Young Kim (R-Calif.) called the federal data showing an increase in deaths “unacceptable,” and pledged to work on policies such as expanding the maternal care workforce.

The caveat: Passing legislation, even bills where both Republicans and Democrats are on board, gets harder when different parties control each chamber, and particularly ahead of a presidential election. 

More from Underwood:

Postpartum Medicaid

There’s one policy gaining traction at the state and federal level: Extending Medicaid benefits to a full year after birth for low-income new mothers. 

The safety net program pays for roughly 4 in 10 births across the United States, and federal law requires states to provide pregnancy-related benefits at least 60 days postpartum. The push is aimed at improving maternal and infant outcomes a year after birth. 

In 2021, Democrats in Congress passed legislation aimed at making it easier for states to extend postpartum Medicaid benefits for a full year. That pathway was only authorized for five years, but key lawmakers clinched a deal to make it permanent last year, which was passed in December’s sweeping government funding.

But Congress fell short of mandating every state do so, to the dismay of some advocates. Yet, an increasing number of both red and blue states have been extending the program. 

According to the Kaiser Family Foundation, 29 states and D.C. have implemented 12-month postpartum coverage. Another eight states are planning to do so. And three states are aiming to seek approval from their legislature before asking for the greenlight from the federal Medicaid agency, including Mississippi, whose Republican governor signed legislation yesterday solidifying the ask for a full year of Medicaid coverage after giving birth. 

Industry Rx

Sanofi follows Lilly, Novo Nordisk in slashing insulin prices

Sanofi announced that it will cut the price of some of its most commonly used insulin by 78 percent in the United States amid mounting political pressure to curb the high cost of the lifesaving medication.

The French drugmaker will also set a $35 cap on out-of-pocket costs for Lantus, its most-prescribed insulin, for all patients with private health plans — a deal it already offers for people without insurance. The changes will take effect January 2024.

The bigger picture: Sanofi was the last of the nation’s three major insulin manufacturers to slash or cap the cost of the drug, which is used by diabetics to manage their blood sugar levels. Earlier that day, Senate Majority Leader Chuck Schumer (D-N.Y.) had sent a letter to Sanofi CEO Paul Hudson urging him to follow in the footsteps of Eli Lilly and Novo Nordisk and lower the cost of the company’s insulin.

Sen. Raphael Warnock (D-Ga.):

Reproductive wars

North Dakota Supreme Court upholds temporary block on abortion ban

Abortion will remain mostly legal in North Dakota for now, after the state’s highest court declined to revive a near-total ban on the procedure while a lawsuit over its constitutionality proceeds in a lower court.

The ruling came yesterday in a lawsuit brought by the Red River Women’s Clinic, which was North Dakota’s only abortion clinic until it relocated to neighboring Moorhead, Minn., last year. North Dakota’s ban, which has been temporarily blocked since August, makes it a felony to perform an abortion. It includes exceptions for cases of rape or incest.

The clinic is arguing that there is a fundamental right to an abortion under the North Dakota constitution. Chief Justice Jon Jensen wrote for the court that while the legislature has the authority to regulate abortion, the clinic has “demonstrated likely success on the merits that there is a fundamental right to an abortion in the limited instances of lifesaving and health-preserving circumstances, and the statute is not narrowly tailored to satisfy strict scrutiny.”

North Dakota state Rep. Karla Rose Hanson (D): 

North Dakota Attorney General Drew Wrigley (R):

Meanwhile …

Utah Gov. Spencer Cox (R) signed legislation yesterday that will effectively ban abortion clinics from operating in the state starting next year, Emily Anderson Stern reports for the Salt Lake Tribune.

Under the law, abortions will still be permitted until 18 weeks of pregnancy, but most will be required to be performed in a hospital. Utah will stop renewing and issuing licenses for abortion clinics starting May 2, and says all abortion clinics should stop operating in the state by January 2024.

Agency alert

Defense Department ramps up mental health services, defers on gun safety recommendations

Defense Secretary Lloyd Austin is ordering the Pentagon to hire more behavioral health specialists and establish a suicide prevention group to improve access to mental health care in the military, the Associated Press reports.

In a memo released yesterday, Austin also ordered military primary care health clinics to screen for unhealthy levels of alcohol use, an effort aimed at making alcohol addiction treatment easier to receive. 

The missing piece: Austin held off on endorsing new restrictions for gun and ammunition purchases by young troops, which an independent committee called for in late February. Instead, he directed a suicide prevention group to produce a report by June 2 assessing the “advisability and feasibility” of the initial panel’s recommendations, along with cost estimates and any barriers to implementing the changes.

Austin’s “orders reflect increasing concerns about suicides in the military. … But his omission of any gun safety and control measures underscores the likelihood that they would face staunch resistance, particularly in Congress, where such legislation has struggled in recent years,” the AP’s Tara Copp and Lolita C. Baldor write.

In other health news

New data emerges on potential covid origin

A team of virus experts said they had found genetic data from a market in Wuhan, China, linking covid-19 with raccoon dogs for sale there, adding evidence that the pandemic could have been ignited by an infected animal dealt through the illegal wildlife trade, the New York Times reports.

The genetic data was drawn from swabs taken from in and around the Huanan Seafood Wholesale Market starting in January 2020, which was shortly after Chinese authorities shut down the market. The animals had been cleared out, but researchers swabbed walls, floors, metal cages and carts, the NYT’s Benjamin Mueller writes. A report with the full details hasn’t been published; the Atlantic first reported the news.

“The jumbling together of genetic material from the virus and the animal does not prove that a raccoon dog itself was infected. And even if a raccoon dog had been infected, it would not be clear that the animal had spread the virus to people. Another animal could have passed the virus to people, or someone infected with the virus could have spread the virus to a raccoon dog,” Benjamin writes.

“But the analysis did establish that raccoon dogs — fluffy animals that are related to foxes and are known to be able to transmit the coronavirus — deposited genetic signatures in the same place where genetic material from the virus was left, the three scientists said. That evidence, they said, was consistent with a scenario in which the virus had spilled into humans from a wild animal.”

  • Pfizer’s antiviral Paxlovid should be approved for the treatment of mild-to-moderate covid in high-risk patients, independent advisers to the Food and Drug Administration recommended yesterday, according to Reuters.
  • For the second time this week, a new poll shows Americans lean strongly toward the belief that the coronavirus leaked from a lab rather than occurring naturally, our colleague Aaron Blake writes. The Quinnipiac University poll shows Americans side with the former view by 64 percent to 22 percent.  
  • Federal Medicaid officials are pushing states to auto-renew Medicaid beneficiaries using IRS and other data once the pandemic-era requirement to maintain continuous enrollment ends on April 1. Doing so could help avoid enrollment glitches and alleviate the administrative burden on states and enrollees, John Wilkerson reports for Stat.

Quote of the week

Health reads

In Florida, showing mental health struggles could get a child detained (By Donna St. George | The Washington Post)

The big-money Medicare policy that has hospitals worried this Congress (By Rachel Cohrs | Stat )

Public Health vs. Economic Growth: Toxic Chemical Rules Pose Test for Biden (By Eric Lipton | The New York Times )

Sugar rush

Thanks for reading! See y’all Monday.

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