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This post is the first in the Roosevelt Institute’s National Women’s Health Week series, which will address pressing issues affecting the health and economic security of women and families in the United States. Today, a look at why conservative policies at the state level are leading to increased maternal mortality rates.

For much of the last decade, maternal mortality rates (MMRs) have declined globally. But in the United States, they have consistently increased and are now at one of the highest points in the last 25 years. If conservatives have their way with social and economic policy, it’s unlikely the U.S. will make significant strides to improve the health of mothers in the near future.

According to a report released last week in the The Lancet, the U.S. now ranks 60th out of 180 countries for maternal deaths. China is number 57. Only seven other countries experienced an increase in MMR over the past 10 years. They include Greece, Afghanistan, and South Sudan. The report estimates that for every 100,000 births, 18.5 mothers die in the U.S. By comparison, 13.5 women die in Iran, 6.1 in the United Kingdom, and only 2.4 in Iceland.

It is no coincidence that the U.S. MMR has increased as poverty rates have steadily climbed. In 2010, Amnesty International released a report that showed women living in the lowest-income areas were twice as likely to suffer a maternal death. States with high rates of poverty were found to have MMRs 77 percent higher than states with fewer residents living below the federal poverty level. Women of color have poverty rates more than double those of white women, and black women are 3-4 times as likely to die from pregnancy-related causes.

The numerous factors that contribute to the high U.S. MMR are complex, as are the solutions required to effectively address the problem. However, one solution is already in place and is working. The Affordable Care Act (ACA) will significantly improve maternal health by mandating coverage of pre-natal, maternity, and post-partum care in all insurance plans. But some of the women in greatest need will remain uninsured and at increased risk because of the refusal of 21 states to expand Medicaid. Many of those states have among the nation’s highest rates of poverty and maternal mortality.

Expanding Medicaid would save women’s lives. A 2010 study conducted in New York City showed that the MMR for women with no insurance was approximately four times higher than for insured women, and that the rate for women insured by Medicaid was comparable to that of women with private insurance.

Many states have higher Medicaid eligibility limits that enable pregnant women with incomes above the standard Medicaid threshold to receive coverage. However, that coverage does not begin until women are already pregnant, and it is often terminated soon after their babies are born. This short coverage period leaves women uninsured for much of their lives and places them at higher risk for health problems that can lead to complications during and after pregnancy. Following implementation of the ACA, some states reduced eligibility limits for pregnant women, and loopholes in other states will leave many women without coverage during this critical time. Expanding Medicaid would provide continuous coverage for women whose incomes exclude them from the program and who do not qualify for subsidized insurance through the exchanges.

Despite the maternal health crisis unfolding in many states, conservative state lawmakers stand firm in their refusal to expand Medicaid, even though the federal government will cover 100 percent of the cost for the first three years and a minimum of 90 percent thereafter. Some states, like Georgia, are so intent on undermining the ACA that they have passed laws to prevent state employees from advocating for expansion and have made it more difficult for people who already qualify for Medicaid to enroll.

Conservatives do not have plans to solve this crisis. In fact, their plans will only make it worse. Family planning cuts and abortion restrictions in places like Texas have shuttered women’s health clinics and obliterated the health infrastructure on which poor women relied for their basic needs. And while many women and their families are still reeling from the recession, cuts to safety net programs like food stamps have led to greater insecurity in health, income, and food than ever before.

Last week’s Lancet report is a stark reminder that women suffer heavy casualties in the partisan battles raging in states across the country. But what we are witnessing today is more than a nasty game of politics: it is a violation of women’s human rights. We should be ashamed and outrage.

Andrea Flynn is a Fellow at the Roosevelt Institute. Follow her on Twitter @dreaflynn

Cross-posted from the Roosevelt Institute’s Next New Deal blog.

The Roosevelt Institute is a non-profit organization devoted to carrying forward the legacy and values of Franklin and Eleanor Roosevelt.

Photo: SEIU International via Flickr

Many Democrats are getting nervous about the upcoming presidential election. Ominous, extensively reported articles by two of the best in the business—the New Yorker's Jeffrey Toobin and The Atlantic's Barton Gellman—outline Boss Trump's plot to keep control of the White House in 2021 no matter how the American people vote.
Trump is hardly making a secret of it. He's pointedly refused to commit to "a peaceful transfer of power."

"Well, we're going to have to see what happens," is how he answered the question. He added that after we "get rid of the ballots"—presumably mail-in ballots he's been whining about for weeks--"there won't be a transfer, frankly. There'll be a continuation."

Of course, Trump himself has always voted by mail, but then brazen hypocrisy is his standard operating mode. If you haven't noticed, he also lies a lot. Without prevaricating, boasting, and bitching, he'd be mute. And even then, he'd still have Twitter. He recently tweeted that the winner "may NEVER BE ACCURATELY DETERMINED" because mail-in ballots make it a "RIGGED ELECTION in waiting."
Gellman gets this part exactly right in The Atlantic: "Let us not hedge about one thing. Donald Trump may win or lose, but he will never concede. Not under any circumstance. Not during the Interregnum and not afterward. If compelled in the end to vacate his office, Trump will insist from exile, as long as he draws breath, that the contest was rigged.
"Trump's invincible commitment to this stance will be the most important fact about the coming Interregnum. It will deform the proceedings from beginning to end. We have not experienced anything like it before."
No, we haven't. However, it's important to remember that Trump makes threats and promises almost daily that never happen. Remember that gigantic border wall Mexico was going to pay for? Trump has built exactly five miles of the fool thing, leaving roughly two thousand to go.
His brilliant cheaper, better health care plan? Non-existent.
On Labor Day, Boss Trump boasted of his unparalleled success in strong-arming Japan into building new auto-manufacturing plants. "They're being built in Ohio, they're being built in South Carolina, North Carolina, they're being built all over and expanded at a level that we've never seen before."
Not a word of that is true. Two new plants, one German, another Swedish have opened in South Carolina, but construction began before Trump took office. Auto industry investment during Barack Obama's second term far exceeded Trump's. His version is sheer make-believe.
But back to the GOP scheme to steal the election.
First, it's clear that even Trump understands that he has virtually no chance of winning the national popular vote. He's been polling in the low 40s, with no sign of change. To have any chance of prevailing in the Electoral College, he's got to do the electoral equivalent of drawing to an inside straight all over again—winning a half-dozen so-called battleground states where he defeated Hillary Clinton in 2016 by the narrowest of margins.
At this writing, that looks highly unlikely. The latest polling in must-win Pennsylvania, for example, shows Trump trailing Joe Biden by nine points. That's a landslide. Trump's down ten in Wisconsin, eight in Michigan. And so on.
So spare me the screeching emails in ALL CAPS, OK? Polls were actually quite accurate in 2016. Trump narrowly defeated the odds. It can happen. But he's in far worse shape this time. Furthermore, early voting turnout is very high, with Democrats outnumbering Republicans two to one.
Hence, The Atlantic reports, "Trump's state and national legal teams are already laying the groundwork for post-election maneuvers that would circumvent the results of the vote count in battleground states."
The plan is clear. Because more Democrats than Republicans are choosing mail-in voting during the COVID pandemic, Trump hopes to prevent those ballots from being counted. Assuming he'll have a narrow "swing state" lead on election night, he'll declare victory and start filing lawsuits. "The red mirage," some Democrats call it.
"As a result," Toobin writes, "the aftermath of the 2020 election has the potential to make 2000 look like a mere skirmish." With Trump in the White House urging armed militias to take to the street.
Mail-in votes take a long time to count. Things could definitely get crazy.
True, but filing a lawsuit to halt a Florida recount was one thing. Filing suits against a half dozen states to prevent votes from being counted at all is quite another. Public reaction would be strong. Also, winning such lawsuits requires serious evidence of fraud. Trumpian bluster ain't evidence.
The Atlantic reports that GOP-controlled state legislatures are thinking about sending Trumpist delegations to the Electoral College regardless of the popular vote winner—theoretically constitutional but currently illegal.
Fat chance. If that's the best they've got, they've got nothing.
Anyway, here's the answer: Vote early, and in person*.

[Editor's note: In some states, receiving an absentee ballot means that a voter can no longer vote in person* or may have to surrender the absentee ballot, including the envelope in which it arrived, at their polling place. Please check with your local election authorities.]