The House Energy and Commerce Health Subcommittee convened witnesses at a Sept. 10 hearing to discuss current legislative proposals to address the rising number of maternal deaths in the United States. The four bills considered were the Mothers and Offspring Mortality and Morbidity Awareness Act (H.R. 1897), the Quality Care for Moms and Babies Act (H.R. 1551), the Maternal Care Access and Reducing Emergencies Act (H.R. 2902), and the Healthy MOMMIES Act (H.R. 2602).
Chair Anna Eshoo (D-Calif.) opened the hearing by noting that the United States is the most dangerous place to raise an infant of any developed nation. She expressed urgency at the nearly 700 women who die, and the nearly 50,000 who are severely injured every year as a result of pregnancy-related complications. Rep. Eshoo stated that this is unacceptable, and that a “high maternal death rate is a reflection of how society values women.”
Ranking Member Michael Burgess (R-Texas) concurred with Eshoo’s concern about maternal deaths, stating that, “Addressing maternal mortality is one of my top priorities.” Burgess also mentioned that there were several bipartisan bills from the 115th Congress that he believes Congress should consider.
Full Committee Chair Greg Walden (R-Ore.) agreed with Burgess but went further in expressing dismay at what he considered to be a partisan hearing. Walden stated that he was disappointed that the Subcommittee was not considering the Excellence in Maternal Health Act (H.R. 4215) which is a companion bill to the Senate Health, Education, Labor, and Pensions (HELP) Committee bill the Lower Health Care Costs Act (S. 1895) [see Washington Highlights, June 28].
Witness Wanda Irving told the story of her daughter who died three weeks after giving birth to her daughter after suffering several unexplainable health conditions. Irving urged the Subcommittee to ensure that they look not only at insurance coverage and financial resources of patients, but other systemic issues in health care. Irving stated that “sending folks to cultural sensitivity or implicit bias training is not going to fix the problem. We must demand the transformation of the health care systems in order to better respond to the needs and priorities of women, especially women of color.”
Elizabeth Howell, MD, MPP, director of Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai, noted that there is a growing recognition that social determinants of health contribute to increased rates of maternal mortality. She also discussed ongoing efforts at the national and state levels to, “address quality of care, standardize care, and improve outcomes for pregnant women” including perinatal quality collaboratives which, “are working to improve quality of care for mothers and babies.”
David Nelson, MD, chief of obstetrics at Parkland Health and Hospital System and assistant professor of Obstetrics and Gynecology at the Division of Maternal-Fetal Medicine at University of Texas Southwestern Medical Center, focused his testimony on highlighting specific efforts Parkland has taken as a “geographically based public health prenatal care program,” to ensure that mothers are adequately cared for by measuring quality data and understanding the areas of improvement. He discussed some of the best practices they have learned across 44 labor and delivery rooms, including a “debrief every time we use [emergency] protocols, to understand if there are opportunities to learn from nurses or physicians.”
Usha Ranji, associate director of women's health policy at the Kaiser Family Foundation, used her opening statement to emphasize the need for extended Medicaid coverage for low-income mothers. Currently, there is no requirement that low-income women remain on Medicaid for more than 60 days postpartum, and in some states, a new mother can lose Medicaid coverage two months after giving birth. She emphasized that access to health coverage before, during, and after pregnancy promoted access to care, and that “for low-income women, Medicaid is comparable to private insurance in terms of many measures of access to care.”
Members of the Committee largely agreed that something needed to be done about the increasing rates of maternal death, with most Members focusing their questions on access to coverage and better training. Rep. Robin Kelly (D-Ill.), the lead sponsor of H.R. 1897, stated that, “Our laws can change the way care is delivered in our hospitals," and that laws, “can support the collection of consistent data on who dies on the way to motherhood, and why.”
Chair Eshoo closed the hearing by stating that the Subcommittee was “not going to rest until we have solid legislation that addresses this.”