WEBVTT - The Maternal Healthcare System Part II – Lab 063 0:00:00.600 --> 0:00:03.800 I'm Tt and I'm Zakijah and from Spotify. This is 0:00:03.880 --> 0:00:20.639 Dope Labs. Welcome to Dope Labs, a weekly podcast that 0:00:20.760 --> 0:00:24.400 maxes hardcore science, pop culture, and how healthy does a friendship. 0:00:24.680 --> 0:00:27.520 This week is part two of our series on maternal health. 0:00:27.920 --> 0:00:29.720 If you haven't listened to last week's Lab yet with 0:00:29.760 --> 0:00:32.960 Simone Tape, we really recommend listening to that one. First, 0:00:33.240 --> 0:00:37.080 we talked to Simone about what services maternal health care encompasses. 0:00:37.479 --> 0:00:40.000 We learn that there's a lot of bottlenecks when it 0:00:40.000 --> 0:00:43.640 comes to getting good maternal healthcare here in the United States, 0:00:43.760 --> 0:00:46.760 and we also dug into disparities in maternal health among 0:00:46.840 --> 0:00:50.200 specific groups. This week, we're zooming out to understand more 0:00:50.240 --> 0:00:52.839 of the context around the state of maternal health care today, 0:00:53.200 --> 0:00:56.120 how we got here, and how to make it better. Okay, 0:00:56.280 --> 0:01:09.199 let's get into the recitation. What do we know? Well, 0:01:09.319 --> 0:01:11.240 you know, like you mentioned, we learned a lot from 0:01:11.319 --> 0:01:14.000 last week's Lab and sadly, we learned if you want 0:01:14.040 --> 0:01:17.280 good care, you basically need to move to Finland. But 0:01:17.319 --> 0:01:19.160 if you aren't trying to move to Finland, here are 0:01:19.160 --> 0:01:21.600 some of the major points from last week's episode about 0:01:21.640 --> 0:01:24.280 the state of maternal health care. Maternal health care in 0:01:24.319 --> 0:01:26.720 the United States is out of date and out of 0:01:26.760 --> 0:01:30.399 touch with the needs of today's birthing population. Yes, we're 0:01:30.400 --> 0:01:33.240 seeing rising rates of both morbidity so those are health 0:01:33.319 --> 0:01:37.320 issues and mortality that's death as it's related to complications 0:01:37.319 --> 0:01:40.400 following pregnancy and giving birth. Some of the major bottlenecks 0:01:40.400 --> 0:01:43.360 and maternal health care include the hurdles that you have 0:01:43.400 --> 0:01:47.199 to jump over making monthly appointments, the lack of options 0:01:47.240 --> 0:01:52.080 of both in person and virtual care, and maternal health 0:01:52.080 --> 0:01:55.920 care deserts. Also, mortality rates are disproportionate among women of color, 0:01:56.080 --> 0:01:58.440 so they are three to four times more likely to 0:01:58.440 --> 0:02:01.640 die from pregnancy or birth come implications. We also found 0:02:01.680 --> 0:02:04.480 out that fifty percent of the birthing population in the 0:02:04.560 --> 0:02:07.280 United States are on Medicaid, which means that they don't 0:02:07.320 --> 0:02:11.200 have equal and equitable access to healthcare. And at the 0:02:11.280 --> 0:02:13.280 end of the last episode, we started talking about the 0:02:13.280 --> 0:02:17.919 Omnibus legislation, which focuses on bringing preventable mortality rates closer 0:02:18.040 --> 0:02:20.320 to zero, and that takes us to kind of what 0:02:20.400 --> 0:02:23.600 we want to know for this lab. Yeah, so my 0:02:23.720 --> 0:02:26.799 first question is why is maternal healthcare in the US 0:02:27.200 --> 0:02:31.200 so bad. With the amount of money that Simone was 0:02:31.240 --> 0:02:34.040 telling us gets poured into our maternal health care system, 0:02:34.200 --> 0:02:36.320 you would think that that would mean that we are 0:02:36.320 --> 0:02:39.200 doing really great, but that's not the case, and I 0:02:39.240 --> 0:02:40.840 want to know why. And I want to know more 0:02:40.840 --> 0:02:44.840 about these programs. You know, So, how does insurance and 0:02:45.120 --> 0:02:48.800 the support that the federal government provides for birthing parents, 0:02:49.200 --> 0:02:51.200 how does that come into play? And why isn't it 0:02:51.240 --> 0:02:53.440 doing its job? It seems like that is such a 0:02:53.440 --> 0:02:56.480 good question. And I also want to know what makes 0:02:56.520 --> 0:03:00.080 maternal healthcare quote unquote good. And once we know but 0:03:00.160 --> 0:03:04.200 makes it good, how do we make it even better? Yes? 0:03:04.480 --> 0:03:06.680 And I think when we consider that, who is the 0:03:06.680 --> 0:03:10.280 weak right should it be nonprofits and private agencies? Or 0:03:10.320 --> 0:03:12.960 are there policies and programs that our government should sponsor 0:03:13.200 --> 0:03:15.960 that might improve outcomes? That's what I want to know. Okay, 0:03:16.040 --> 0:03:19.919 I think we've got enough questions. Yes, let's jump into 0:03:19.960 --> 0:03:20.519 the dissection. 0:03:27.760 --> 0:03:28.600 Let just ask you. 0:03:32.080 --> 0:03:34.720 Our guest for today's lab is doctor Sarah Benattar. 0:03:35.040 --> 0:03:38.880 My name is Sarah Benattar. I'm a principal research associated 0:03:39.160 --> 0:03:42.360 the Urban Institute in the Health Policy Center, So I 0:03:42.520 --> 0:03:48.080 do research mostly focused on maternal and child health. 0:03:48.320 --> 0:03:50.440 The first thing we wanted to know from doctor Benatar 0:03:50.760 --> 0:03:54.360 is why maternal healthcare in the United States is so poor. 0:03:54.760 --> 0:03:56.520 She said, it's not about money. 0:03:56.720 --> 0:04:01.600 The US spends more money on maternal health than any 0:04:01.600 --> 0:04:05.440 other country in the entire world, twenty five percent more 0:04:05.560 --> 0:04:10.040 per capita than the next highest spender. Despite all of that, 0:04:10.360 --> 0:04:14.440 we have some of the worst outcomes for pregnant people 0:04:14.640 --> 0:04:15.600 and infants. 0:04:15.840 --> 0:04:18.160 And let's talk about those outcomes. We learned from simone 0:04:18.240 --> 0:04:22.000 last week about increasing mortality rates, but what are the specifics. 0:04:22.240 --> 0:04:25.400 In twenty eighteen, the rate was seventeen per one hundred 0:04:25.400 --> 0:04:28.520 thousand births resulted in a maternal death. That went up 0:04:28.560 --> 0:04:33.119 in twenty nineteen to over twenty deaths per one hundred 0:04:33.200 --> 0:04:36.520 thousand pregnant people. In twenty twenty that was even higher 0:04:36.520 --> 0:04:40.159 at twenty three point eight. The next highest rate for 0:04:40.200 --> 0:04:43.720 a high income country is half that, so in Canada 0:04:43.760 --> 0:04:46.960 and France the rates are more around eight per one 0:04:47.000 --> 0:04:48.440 hundred thousand deaths. 0:04:48.680 --> 0:04:52.680 And Sarah told us historically this upward trajectory hasn't been 0:04:52.720 --> 0:04:53.200 the trend. 0:04:53.480 --> 0:04:57.640 The Commonwealth Fund has this terrific piece that worth looking at, 0:04:57.720 --> 0:05:01.359 where they have a chart of maternal mortalit starting in 0:05:01.400 --> 0:05:05.200 about nineteen eighteen, and you can see that it starts 0:05:05.560 --> 0:05:08.800 really really high, and then by the nineteen thirties or so, 0:05:08.880 --> 0:05:13.200 it's considerably lower, and it just keeps on going down 0:05:13.360 --> 0:05:17.240 until about the nineteen eighties, and in the nineteen eighties 0:05:17.320 --> 0:05:20.560 it goes up again, and now they just are creeping 0:05:20.680 --> 0:05:21.760 up consistently. 0:05:22.000 --> 0:05:24.920 So this chart is looking at death per one hundred 0:05:24.920 --> 0:05:28.360 thousand pregnant people. In the eighties and nineties, you're only 0:05:28.360 --> 0:05:31.360 seeing about seven to eight deaths. But it's really sobering 0:05:31.400 --> 0:05:33.640 to learn that today we're up to about twenty three 0:05:33.680 --> 0:05:37.360 deaths per one hundred thousand pregnant people. That's a problem huge. 0:05:37.560 --> 0:05:39.719 Twenty three sounds like it's small, but when you look 0:05:39.760 --> 0:05:45.560 at like what it was significant, Yeah, yeah, anything increasing 0:05:45.600 --> 0:05:48.080 by times three you need to check on it. 0:05:48.240 --> 0:05:51.800 Yes, a good segment of that can be attributed to 0:05:51.920 --> 0:05:57.000 discriminatory healthcare practices and systemic racism. I think because there 0:05:57.080 --> 0:06:01.640 is just an incredible amount of us and I think 0:06:01.720 --> 0:06:05.880 it's relatively well demonstrated that is not helpful for a pregnancy. 0:06:06.160 --> 0:06:09.040 In addition to mortality rates, there are other stats that 0:06:09.080 --> 0:06:12.320 doctor Benattar points to that indicate the US is not 0:06:12.520 --> 0:06:14.960 up to par when it comes to maternal healthcare. 0:06:14.760 --> 0:06:17.200 In the US. Some of the things that we really 0:06:17.279 --> 0:06:20.640 pay close attention to our low birth weight, so that's 0:06:20.760 --> 0:06:24.480 a baby that's born weighing less than five pounds eight ounces, 0:06:24.640 --> 0:06:29.080 and pre term birth, which is being delivered before thirty 0:06:29.160 --> 0:06:33.640 seven weeks gestation. So those are some of the bigger indicators. 0:06:33.680 --> 0:06:37.599 Another thing are the CEA section rates. Approximately a third 0:06:38.080 --> 0:06:42.040 of all deliveries are done by c section. Now the 0:06:42.160 --> 0:06:46.600 who said that the ideal rate would be around fifteen percent. 0:06:47.040 --> 0:06:49.760 Cesarean deliveries, which are also known as c sections, do 0:06:49.880 --> 0:06:52.839 have more risk than delivering a baby baginally, but they're 0:06:52.880 --> 0:06:55.640 often medically necessary in order to protect the health of 0:06:55.640 --> 0:06:58.000 a birthing parent or a baby. There are some common 0:06:58.080 --> 0:07:01.360 chronic health conditions that sometimes require section delivery, and those 0:07:01.440 --> 0:07:04.880 include heart disease, high blood pressure, or gestational diabetes. And 0:07:04.920 --> 0:07:07.680 the disparities we've been talking about permeate all of these 0:07:07.680 --> 0:07:08.480 different areas. 0:07:08.600 --> 0:07:12.560 If you look at this by race and ethnicity, the rates, 0:07:12.720 --> 0:07:17.560 particularly for black women and birthing people, are much higher, 0:07:17.680 --> 0:07:21.760 so maternal mortality rates can be three to four times higher. 0:07:22.000 --> 0:07:25.800 Sea section rates are quite a bit higher low birth 0:07:25.880 --> 0:07:28.280 rate and preach and birth rates are also higher for 0:07:28.400 --> 0:07:29.960 Black women and birthing people. 0:07:30.280 --> 0:07:34.720 The math ain't mathing. Okay, Rights spends the most money 0:07:34.800 --> 0:07:39.280 on maternal healthcare but has the worst outcomes, especially for 0:07:39.320 --> 0:07:42.480 Black women and birthen people. We need to understand more. 0:07:42.560 --> 0:07:45.600 So we ask doctor Benettar, what is going on? 0:07:46.160 --> 0:07:50.320 So many people who become pregnant and are then engaging 0:07:50.360 --> 0:07:53.960 in prenatal care have not necessarily had access to high 0:07:54.040 --> 0:07:57.720 quality care prior to that. And I have also experienced 0:07:57.960 --> 0:08:01.720 all kinds of discrimination care. But you know, we're talking 0:08:01.760 --> 0:08:05.840 about people coming into pregnancy maybe haven't had, especially prior 0:08:05.880 --> 0:08:09.840 to the ACA, any medical insurance or coverage prior. Because 0:08:10.000 --> 0:08:13.680 Medicaid pays for over forty percent of all births in 0:08:13.720 --> 0:08:16.840 the United States, and for black women and breathing people 0:08:17.000 --> 0:08:19.800 is hired more like sixty five percent of births. 0:08:20.040 --> 0:08:22.840 Medicaid is a federal and state program that helps with 0:08:23.040 --> 0:08:27.440 health care costs for Americans with limited income and resources, 0:08:27.760 --> 0:08:30.640 and it's the largest source of funding for medical and 0:08:30.680 --> 0:08:33.439 health related services for people with low income in the 0:08:33.559 --> 0:08:37.600 United States. So Medicaid is such an important program to 0:08:37.640 --> 0:08:40.640 have because it provides healthcare to a portion of the 0:08:40.640 --> 0:08:44.720 population that wouldn't have it otherwise. But because it is 0:08:44.760 --> 0:08:47.920 regulated at the state level as well as the federal level, 0:08:48.200 --> 0:08:50.760 there are some parts of it that, you know, depending 0:08:50.800 --> 0:08:54.000 on the state that you're in, have some pitfalls. Insurance, 0:08:54.040 --> 0:08:56.920 I think is one of the trickiest things in adulting, 0:08:57.960 --> 0:09:01.080 don't you think, Like for real, for real, it's really wild. 0:09:01.320 --> 0:09:04.560 Doctor Benattar mentioned the ACA, or the Affordable Care Act, 0:09:04.679 --> 0:09:08.120 which was passed in twenty ten under the Obama administration. 0:09:08.440 --> 0:09:11.439 The ACA was meant to expand health care coverage for 0:09:11.679 --> 0:09:16.840 millions of uninsured Americans. It also expanded Medicaid eligibility and 0:09:16.880 --> 0:09:21.000 created the marketplace where people can purchase private insurance. And 0:09:21.120 --> 0:09:23.880 that private insurance is very expensive, by the way, very 0:09:23.920 --> 0:09:27.480 But before the Affordable Care Act, you had to basically 0:09:27.520 --> 0:09:29.520 have a job if you wanted good health care. And 0:09:29.600 --> 0:09:31.600 isn't that kind of wild when we stepped back from it, 0:09:32.800 --> 0:09:35.160 Like it's like, Okay, you only have the right to 0:09:35.520 --> 0:09:39.360 live if you are working, working, and not all jobs 0:09:39.400 --> 0:09:42.120 provide health care. Exactly. I have health I have a 0:09:42.160 --> 0:09:45.360 body whether I'm working or not, exactly, And that's something 0:09:45.440 --> 0:09:48.880 that's unique to the United States. Because universal health care 0:09:49.000 --> 0:09:52.040 is something that they have in Europe and Canada and 0:09:52.120 --> 0:09:54.480 we're just slow to get on it. People are still 0:09:54.679 --> 0:09:58.920 fighting the Affordable Care Act, also called Obamacare by folks 0:09:58.960 --> 0:10:01.760 who want to make it seems like it's something that 0:10:02.000 --> 0:10:06.920 is partisan, like people getting quality healthcare as a partisan thing. 0:10:07.160 --> 0:10:10.080 It's not well. In my opinion, it shouldn't be. But 0:10:10.200 --> 0:10:13.040 here we are. Here, we are at this big age, 0:10:13.120 --> 0:10:16.520 this country, at this big age set up having a 0:10:16.520 --> 0:10:19.720 temperate tantrum around healthcare. Get it together or you're not 0:10:19.760 --> 0:10:24.120 getting anything. Yeah. Another answer to the question how did 0:10:24.160 --> 0:10:26.840 we get here is what doctor Benattar calls a very 0:10:26.920 --> 0:10:31.000 medicalized approach to pregnancy, one that values profit over people. 0:10:31.200 --> 0:10:35.400 Many other places approach pregnancy from a perspective that's much 0:10:35.400 --> 0:10:39.240 more normalized, where this is a natural process that maybe 0:10:39.320 --> 0:10:42.160 sometimes requires a little bit of help, but most of 0:10:42.240 --> 0:10:45.680 the time we can support women through it and have 0:10:45.760 --> 0:10:52.440 a healthy outcome. The medicalized model also maximizes profit. Many times, 0:10:52.480 --> 0:10:56.280 these visits are very short, maybe fifteen minutes. Like if 0:10:56.320 --> 0:10:59.440 you think about a hospital based clinic where we're trying 0:10:59.440 --> 0:11:02.760 to get as many people in, especially because Medicaid is 0:11:02.760 --> 0:11:05.719 one of the largest payers there are often high nose 0:11:05.800 --> 0:11:06.960 show rates. 0:11:06.720 --> 0:11:09.120 And that could be because of the factors we talked 0:11:09.120 --> 0:11:12.720 about last week with simone, lack of access to childcare 0:11:13.160 --> 0:11:17.480 and transportation, no telehealth options, and maternal health care deserts. 0:11:17.840 --> 0:11:20.520 So there are these short visits in which maybe there's 0:11:20.559 --> 0:11:25.160 been no pre existing relationship, and many people will express 0:11:25.360 --> 0:11:28.560 that they aren't being listened to. And lots of people 0:11:28.760 --> 0:11:32.000 have all kinds of other social determinants that are affecting 0:11:32.040 --> 0:11:36.719 their health like housing, insecurity, food and security, anxiety, depression. 0:11:37.120 --> 0:11:38.000 The list is long. 0:11:38.360 --> 0:11:41.199 Another trend that directly correlates to worsening prenatal care in 0:11:41.200 --> 0:11:44.480 the United States is the growing OBGYN shortage, and we 0:11:44.600 --> 0:11:47.000 mentioned that last week, but to help you understand it 0:11:47.040 --> 0:11:49.560 a little bit better, let's think about it from the 0:11:49.760 --> 0:11:53.160 entire national perspective. So not just rural areas. If you 0:11:53.200 --> 0:11:55.200 look at all the counties in the United States, half 0:11:55.200 --> 0:11:58.560 of them do not have a single obgyn. That's major. 0:11:58.720 --> 0:12:02.719 That's wild, that is major. My whole county. Yeah, when 0:12:02.720 --> 0:12:06.040 I think about going to another county for anything, a 0:12:06.080 --> 0:12:08.960 specific grocery store because of a specific shop that I like, 0:12:09.240 --> 0:12:11.880 Oh my gosh, so far, so far, this is going 0:12:11.960 --> 0:12:15.200 to be a trek. Now, imagine doing that pregnant mm 0:12:15.280 --> 0:12:24.560 hm ugh. In part one of this series, Simone said 0:12:24.559 --> 0:12:27.920 that fifty percent of the birthing population is on Medicaid. 0:12:28.360 --> 0:12:30.440 And now we know that Medicaid is one of the 0:12:30.600 --> 0:12:34.200 largest payers of maternal healthcare in the United States, covering 0:12:34.200 --> 0:12:36.840 about forty percent of all births in the United States 0:12:36.920 --> 0:12:39.680 and sixty five percent of births for Black women and 0:12:39.760 --> 0:12:42.679 birthing people. So let's break down Medicaid more in the 0:12:42.679 --> 0:12:43.959 context of maternal health. 0:12:44.160 --> 0:12:49.000 In the nineteen eighties, Medicaid expanded to include pregnant people. 0:12:49.200 --> 0:12:52.920 So prior to that, Medicaid was almost exclusively a program 0:12:53.000 --> 0:12:57.479 for children and for adults with very, very low incomes, 0:12:57.720 --> 0:12:59.679 so it was really pretty restrictive. 0:13:00.240 --> 0:13:03.480 Eligible to receive Medicaid, most people have to meet an 0:13:03.480 --> 0:13:04.439 income requirement. 0:13:04.679 --> 0:13:09.120 Each state decides how high the income threshold goes for 0:13:09.200 --> 0:13:12.520 pregnancy related Medicaid coverage. So in one state, you could 0:13:12.559 --> 0:13:15.480 make a certain amount of money and qualify for pregnancy 0:13:15.520 --> 0:13:18.440 related Medicaid, but in another state you could make thirty 0:13:18.480 --> 0:13:21.800 percent more and still qualify for pregnancy related Medicaid. 0:13:21.880 --> 0:13:25.160 Let's break that down. So when doctor Benetar mentions qualifying. 0:13:25.200 --> 0:13:28.280 What she's talking about is the income level, how much 0:13:28.320 --> 0:13:31.920 income you make as it relates to the federal poverty level. 0:13:32.040 --> 0:13:34.720 And so the federal poverty level is thirteen thousand, five 0:13:34.760 --> 0:13:38.520 hundred dollars annually for individuals and around eighteen k for 0:13:38.679 --> 0:13:41.800 families of two. And the gotcha, gotcha with all of 0:13:41.840 --> 0:13:46.319 this is exactly what doctor Benattar said. It changes between states. 0:13:46.360 --> 0:13:49.120 So we looked up what it would be for Maryland. 0:13:49.640 --> 0:13:52.959 So let's say it's you and your partner and one 0:13:53.000 --> 0:13:56.480 of you is pregnant. You qualify for Medicaid if you 0:13:56.559 --> 0:14:00.400 make up to four thousand, twenty nine dollars per month. Okay, 0:14:00.480 --> 0:14:05.160 so that's for Maryland. For Alabama, same situation, you your partner, 0:14:05.320 --> 0:14:08.560 one of you is pregnant, You qualify if you make 0:14:08.800 --> 0:14:12.160 up to two two and twenty eight dollars per month. 0:14:12.640 --> 0:14:15.280 That's a lot lower. That is a lot lower. I 0:14:15.280 --> 0:14:17.719 would want to move to Maryland if I could. Right, 0:14:17.840 --> 0:14:20.520 You think about the quality of life of the pregnant 0:14:20.520 --> 0:14:24.920 folks in Alabama who are looking to qualify for Medicaid. 0:14:25.080 --> 0:14:28.080 That annual income, when you do the math, that's not 0:14:28.160 --> 0:14:29.760 a lot of money. I mean, I think that's the 0:14:29.800 --> 0:14:32.520 interesting thing that this is state by state, you know, 0:14:33.240 --> 0:14:36.080 and this is a much higher percentage of the federal 0:14:36.120 --> 0:14:39.360 poverty level that's allowed, and so this is gracious for 0:14:39.520 --> 0:14:41.680 maternal health care. We won't even get into what it 0:14:41.720 --> 0:14:44.240 looks like how little income you can make if you 0:14:44.280 --> 0:14:47.080 want to qualify for Medicaid and you're not pregnant right now. 0:14:47.080 --> 0:14:49.400 And this is where I think we see these insurance gaps, 0:14:49.400 --> 0:14:51.240 and when people are pregnant, they show up and they 0:14:51.280 --> 0:14:54.720 haven't had good health care leading up to this. Absolutely, 0:14:54.720 --> 0:14:56.440 I think this is how we get that vicious cycle 0:14:56.480 --> 0:15:01.200 of complications and increase morbidity and mortality. Absolutely, because all 0:15:01.240 --> 0:15:04.160 of these things touch Every aspect of your life is 0:15:04.200 --> 0:15:06.760 touching this. So if you have to make below a 0:15:06.760 --> 0:15:08.920 certain amount, that means that's going to affect do you 0:15:08.960 --> 0:15:12.040 have a car, do you have access to technology, The 0:15:12.120 --> 0:15:14.520 quality of your food, and all of these will affect 0:15:14.520 --> 0:15:17.760 your pregnancy, all of it. Where you can live, air 0:15:17.880 --> 0:15:21.160 quality because of where you're living. Yes, yes, I was 0:15:21.200 --> 0:15:22.800 gonna say, this is just tying back to so many 0:15:22.840 --> 0:15:26.400 episodes what doctor Tate said about if you're living with 0:15:26.480 --> 0:15:28.720 somebody else, if they make a little bit more income, 0:15:28.720 --> 0:15:30.400 it may not even be yours to spend. But what 0:15:30.400 --> 0:15:33.640 does that mean for your household amount? Right? And if 0:15:33.680 --> 0:15:35.680 you qualify or not, and then what does that mean 0:15:35.680 --> 0:15:39.440 for your support throughout your pregnancy? Absolutely, it's just oh 0:15:39.520 --> 0:15:41.560 my goodness, there are so many, so many ways to 0:15:41.600 --> 0:15:43.320 look at this. Yeah, because I mean even when we 0:15:43.320 --> 0:15:45.520 think back to our sleep episodes with doctor Jean Louis 0:15:45.640 --> 0:15:48.720 mm hm and talking about the quality of your health 0:15:48.840 --> 0:15:52.320 is dependent on your zip code. Now, compound that with 0:15:52.600 --> 0:15:55.960 access to proper health care, access to maternal health care 0:15:56.120 --> 0:15:59.360 exact A is also dependent on your existence, dependent on 0:15:59.400 --> 0:16:01.520 your zip code. You're just stacking those things up. 0:16:02.280 --> 0:16:07.520 In many states now, the threshold for eligibility is pretty high. 0:16:07.720 --> 0:16:11.359 You could be to two hundred ish percent of poverty 0:16:11.400 --> 0:16:15.320 and qualify for pregnancy related Medicaid coverage, and then Medicaid 0:16:15.400 --> 0:16:19.520 covers all of your pregnancy related healthcare needs. It also 0:16:19.640 --> 0:16:22.160 covers any other healthcare related needs you have. 0:16:22.480 --> 0:16:25.240 Since nineteen eighty nine, pregnant women with incomes at or 0:16:25.280 --> 0:16:28.040 below one hundred thirty three percent of the federal poverty 0:16:28.120 --> 0:16:31.560 level have been a mandatory Medicaid eligibility group. So that 0:16:31.640 --> 0:16:33.600 means you can make up to one hundred percent of 0:16:33.600 --> 0:16:35.880 the poverty level plus an additional thirty three percent. They're 0:16:35.920 --> 0:16:38.440 giving you a little bonus area there, you know. So 0:16:38.520 --> 0:16:40.720 if you may up to one hundred thirty three percent 0:16:40.880 --> 0:16:45.640 of the poverty level, then your mandatory, like it's mandatory 0:16:45.680 --> 0:16:48.400 that you are included in Medicaid coverage. 0:16:48.640 --> 0:16:53.160 Every pregnant individual in the United States who becomes pregnant 0:16:53.280 --> 0:16:57.960 should qualify for either Medicaid or the Children's Health Insurance Program. 0:16:58.120 --> 0:17:00.680 The Children's Health Insurance Program OR was part of the 0:17:00.720 --> 0:17:03.080 Balanced Budget Act of nineteen ninety seven, and so this 0:17:03.120 --> 0:17:06.119 program was created to provide low cost health coverage for 0:17:06.200 --> 0:17:09.760 children who wouldn't qualify for Medicaid but are still relatively 0:17:09.840 --> 0:17:12.800 low income. Like Medicaid, each state is still determining the 0:17:12.840 --> 0:17:16.320 eligibility requirements for CHIP, so really it's plugging a gap. 0:17:16.480 --> 0:17:21.639 If the Children's Health Insurance Program covers some pregnancies that 0:17:22.080 --> 0:17:28.520 undocumented people are experiencing because it is focused on the 0:17:28.680 --> 0:17:33.000 unborn child in that situation because they would not otherwise 0:17:33.119 --> 0:17:37.440 qualify for a federally funded health insurance program. 0:17:37.800 --> 0:17:40.800 It's like, we have some stop gaps, but it's not 0:17:40.960 --> 0:17:43.560 one hundred percent. So in the case of CHIP, you know, 0:17:43.600 --> 0:17:47.199 if you imagine an undocumented person that's pregnant, they're not 0:17:47.280 --> 0:17:52.080 eligible for Medicaid, but their unborn child is eligible for CHIP, 0:17:52.119 --> 0:17:55.720 the Children's Health Insurance program, Right, but the birthing parent 0:17:56.320 --> 0:17:59.520 still isn't covered by either of those two things. Right, 0:17:59.760 --> 0:18:04.280 So we have some stop gaps, but it's still leaky. 0:18:04.480 --> 0:18:08.040 It's still leaky. Yeah, let's take a break and when 0:18:08.040 --> 0:18:11.200 we come back, we'll talk about postpartum care and some 0:18:11.320 --> 0:18:14.480 legislation that's coming out to hopefully improve maternal health in 0:18:14.480 --> 0:18:17.359 the United States. Plus stick around to hear about a 0:18:17.400 --> 0:18:39.719 special episode that we're working on. We're back, but before 0:18:39.800 --> 0:18:42.320 we get back to the lab, two things. Next week, 0:18:42.359 --> 0:18:45.160 we're talking all about our therapy and how art can 0:18:45.200 --> 0:18:48.480 be utilized to help us in our mental health journeys. 0:18:48.600 --> 0:18:51.360 And we're also reaching out to ask for your input 0:18:51.480 --> 0:18:54.480 and feedback. We are doing a special episode calling out 0:18:54.520 --> 0:18:58.119 the lgbt QIA community in stem. If you are a 0:18:58.119 --> 0:19:00.520 member of this community, we want to hear from you. 0:19:00.560 --> 0:19:03.040 Call us at two zero two five six seven seven 0:19:03.200 --> 0:19:05.480 zero two eight and tell us about your work, what 0:19:05.560 --> 0:19:08.520 you do. We want to hear it all. Let's get 0:19:08.520 --> 0:19:10.880 back to the lab. We've been talking with doctor Benattar 0:19:11.000 --> 0:19:14.920 about Medicaid CHIP, which is the Children's Health Insurance Program. 0:19:15.200 --> 0:19:18.000 And these are two programs meant to expand maternal health 0:19:18.040 --> 0:19:20.960 care coverage in the United States, and how complicated it 0:19:21.000 --> 0:19:23.800 can be to qualify for these programs. So let's say 0:19:23.840 --> 0:19:25.800 you do qualify, You've jumped through all the hoops to 0:19:25.840 --> 0:19:29.600 get there. Medicaid coverage includes, you know, pregnancies with complications 0:19:29.640 --> 0:19:33.240 and postpartum healthcare. Two. So remember how simone said that 0:19:33.280 --> 0:19:36.360 typically there is a six week post birth follow up 0:19:36.440 --> 0:19:39.880 and then that's it. If you have Medicaid. The minimum 0:19:39.880 --> 0:19:42.439 requirement is that pregnant people remain covered for up to 0:19:42.480 --> 0:19:45.160 sixty days postpartum. Now I'm gonna let you do the math. 0:19:45.160 --> 0:19:48.520 For six weeks time seven days. That's not giving you 0:19:48.560 --> 0:19:50.520 a lot of room if you miss that right hitting 0:19:50.560 --> 0:19:52.160 on the nose at six weeks, you know what I'm saying. 0:19:52.200 --> 0:19:55.200 Tt Yeah. And so in many states there are now 0:19:55.320 --> 0:19:58.399 postpartum extensions of Medicaid that would let you stay covered 0:19:58.520 --> 0:20:01.040 up to a year after giving birth. And we want 0:20:01.040 --> 0:20:02.960 to pause and really take a moment to talk about 0:20:02.960 --> 0:20:03.720 postpartum care. 0:20:03.920 --> 0:20:07.760 Sometimes we'd refer to the first three months postpartum as 0:20:07.800 --> 0:20:11.679 a fourth trimester, and I think that more attention paid 0:20:11.760 --> 0:20:15.640 to that fourth trimester would be really valuable. 0:20:15.440 --> 0:20:18.480 When it comes to maternal health. So much focuses on 0:20:18.520 --> 0:20:21.960 the time leading up to birth and then the birth itself, 0:20:22.080 --> 0:20:24.080 and then there's just a huge drop off in care. 0:20:24.240 --> 0:20:27.480 But having good medical care and a strong support system 0:20:27.640 --> 0:20:31.359 is just as crucial, if not more so, after birth 0:20:31.400 --> 0:20:32.400 when the baby is here. 0:20:32.640 --> 0:20:34.840 Yes, there are a few things to think about. One 0:20:35.160 --> 0:20:39.159 is the safety of the mother or the birthing parent, 0:20:39.520 --> 0:20:43.439 because there are a number of sequela that could happen 0:20:43.840 --> 0:20:47.520 that could really endanger the life of the person who 0:20:47.680 --> 0:20:51.399 just delivered a baby, and that is generally around hemorrhage 0:20:51.560 --> 0:20:52.280 and basequela. 0:20:52.359 --> 0:20:55.400 She just means a condition resulting from a previous condition, 0:20:55.560 --> 0:20:57.679 so think of it as like another domino in a 0:20:57.720 --> 0:21:01.280 sequence of conditions or effects. Hemorrhage is a rare but 0:21:01.640 --> 0:21:04.720 very serious condition when a person has heavy bleeding after 0:21:04.760 --> 0:21:07.679 giving birth. It's usually treatable as long as you have 0:21:07.800 --> 0:21:10.480 access to good medical care, and if you don't and 0:21:10.480 --> 0:21:12.280 it's not treated, it can be fatal. 0:21:12.600 --> 0:21:16.439 Then there's support around breastfeeding if that is a choice 0:21:16.440 --> 0:21:19.600 that has been made and even if it's not, then 0:21:19.640 --> 0:21:23.199 there's like making sure that there is enough formula available. 0:21:23.400 --> 0:21:26.320 It's the wrong formula if it doesn't taste good. If 0:21:26.359 --> 0:21:29.480 your child has allergies, it can be a real struggle. 0:21:29.480 --> 0:21:31.960 And not being able to provide adequate food for your 0:21:32.080 --> 0:21:35.640 child is just heartbreaking. And diapers the same thing. 0:21:36.040 --> 0:21:38.440 If you make the decision to breastfeed, there are all 0:21:38.560 --> 0:21:41.280 kinds of things to deal with, like getting a newborn 0:21:41.280 --> 0:21:45.960 to latch, sore chapped nipples, really painful infection of milk 0:21:46.040 --> 0:21:49.639 ducks called mestitis, just to name a few. And with formula. 0:21:50.000 --> 0:21:52.679 Next time you go to the pharmacy, go look at 0:21:52.760 --> 0:21:58.600 those formula prices and diapers. All of it is so expensive. 0:21:59.000 --> 0:22:02.160 They even have in formula behind those little clear cases 0:22:02.200 --> 0:22:05.000 so that you have to call a salesperson over to 0:22:05.280 --> 0:22:08.359 unlock it for you. And so there are some programs 0:22:08.640 --> 0:22:12.439 like Women Infants, Children or WICK that will cover the 0:22:12.480 --> 0:22:16.080 cost of formula for low income families. Postpartum depression is 0:22:16.119 --> 0:22:18.879 also a huge health risk during the fourth trimester. Remember 0:22:18.880 --> 0:22:21.119 someone said that according to the CDC, about one in 0:22:21.200 --> 0:22:23.720 eight women experience symptoms of postpartum depression. 0:22:23.880 --> 0:22:26.000 Of course, all the other things that a new parent 0:22:26.119 --> 0:22:30.320 might need like housing, and there could be intimate partner violence. 0:22:30.760 --> 0:22:34.359 So there are programs out there that are designed to 0:22:34.359 --> 0:22:38.520 help support new parents, and sometimes duela care will extend 0:22:38.600 --> 0:22:40.560 to the postpartum period as well. 0:22:41.119 --> 0:22:44.840 All of this on top of very little sleep and 0:22:45.040 --> 0:22:49.119 pressure of keeping this little animal alive. It's no wonder 0:22:49.160 --> 0:22:52.320 that postpartum care is advised for up to a year 0:22:52.400 --> 0:22:56.439