The Biggest Threats to Maternal Health Lurking in President Trump’s Health Care Cuts

Republican health care cuts exceeding $1 trillion threaten to destabilize maternal health, posing significant risks to postpartum coverage and reproductive health care, support systems on which millions of mothers rely.

Medicaid is the cornerstone of maternal health care in the United States. It covers 41% of all births nationwide, and more than half in states like Louisiana, Mississippi, New Mexico, and Oklahoma. But the Republican health care cuts outlined in the law (H.R. 1) will wreak havoc on state Medicaid programs, drawing into question whether states will be able to continue to support mothers in the same way over the next 10 years and beyond.

The nonpartisan Congressional Budget Office (CBO) estimated that more than 15 million people could lose coverage because of the cuts - making it harder to enroll in and maintain Medicaid coverage and impacting private coverage affordability. No matter the insurance provider, this will affect all household budgets.

As federal funding options are gutted, states are left with stark choices: cut coverage and services or take on political challenges to secure new funding streams. Threatened Medicaid maternal health coverage and benefits include postpartum coverage, eligibility levels, fertility services, reproductive health benefits, access to reproductive health providers, doulas and other community health workers, and more.

While many aspects of maternal health care in Medicaid will surely face challenges, two direct threats on the horizon are outlined below.

Threat # 1: Defunding Reproductive Health Care  

Trump's health care cuts ban Medicaid funding for major frontline reproductive health care providers that offer a full range of reproductive health services such as birth control, cancer screenings, testing and treatment for sexually transmitted infections (STIs), well-woman exams, vaccinations and abortion care.

The "defund" provision of the law is a blatant attempt to drive independent abortion care providers and Planned Parenthood out of business because they provide abortion care. But in their haste to target abortion, the Republican budget bill will have wide-ranging impacts on women in states across the country who receive services through Planned Parenthood and other reproductive health care providers, including at one of the 200 Planned Parenthood health centers that may be forced to close. These changes will disproportionally impact those with lower incomes or who live in underserved areas, including rural communities.

Planned Parenthood alone delivers a range of critical health care services to nearly 2.1 million patients each year, providing support to women throughout their lives, including the time leading up to, during, and after pregnancy. For 65% of women who receive services through a Planned Parenthood facility, they consider it their regular doctor. The same is true for other independent abortion care providers.

The closure of health centers across more than two dozen states strips health care access away from women when they need it most. Access to primary and preventive care for women in their reproductive years leads to better pregnancy outcomes for moms and babies.

And the harm won't be felt equally. Communities of color, LGBTQ+ patients, and those in rural or medically underserved communities face the greatest barriers to care and will be hit the hardest. Nearly 40% of Planned Parenthood's patients are women of color, including approximately 573,000 Latino and 350,000 Black patients  - groups that already face stark disparities in maternal mortality and reproductive health outcomes.

This threat is playing out in real time. Despite legal efforts challenging the "defunding" provision, efforts to block Medicaid funding for reproductive health care providers are well underway. To learn more about why Planned Parenthood and independent abortion care providers remain essential, please check out this blog.

Threat #2: Driving Millions of Women Off Their Health Coverage

Medicaid has been a critical tool in fighting the maternal health care crisis. Access to pre-pregnancy coverage under Medicaid expansion is associated with an increased use in prenatal services, reduction in infant mortality rates, and a 17% reduction in hospitalization during the first 60 days postpartum.

Beginning in 2027, Medicaid beneficiaries in the expansion population will be required to meet onerous 80 hour-a-month work reporting requirements or be kicked off their health care. Experts estimate the administrative burden associated with meeting harsh work requirements will result in 15 million people losing their health insurance.

While the new work reporting requirements won't apply to pregnant women or mothers with younger children on Medicaid, many exemptions must be documented by new and burdensome requirements. These requirements will create challenges for many women of reproductive age in need of Medicaid coverage - particularly for women who do not work for pay due to childcare responsibilities, illness, or school attendance. While many women who are unable to work will qualify for exemptions, the process of applying for coverage, receiving exemptions, and continually verifying eligibility can be arduous for individuals to manage or result in delays or lapses in coverage.

Consistent health care coverage before, after and during pregnancy is foundational to health of mothers and babies through routine health visits and management of chronic health conditions that can be dangerous during pregnancy - such as high blood pressure or diabetes.

Work reporting requirements will put the health and well-being of millions of reproductive age women at risk.

Hold Congress Accountable for Harmful Cuts to Our Health Care

The threats to Medicaid and to moms aren't just coming from Trump's health care cuts, this is the first stop on a very long road. That's why we all must act now. Send a message to your Representative(s) and hold them accountable for their vote.

We must also continue the fight at the state level, working with Medicaid agencies and legislatures to protect coverage, reduce harm and keep vital services intact. Together, we can work to defend Medicaid and ensure moms, babies, and families have the care they need and deserve.

We must also continue the fight at the state level, working with Medicaid agencies and legislatures to protect coverage, reduce harm and keep vital services intact. Together, we can work to defend Medicaid and ensure moms, babies, and families have the care they need and deserve.

We're here to support advocates, partners, and state leaders in this work. If you need help with policy, strategy, or communications, please reach out.