Public health experts have long warned that such gaps can have profound consequences for women’s health across their lifespans and are a critical factor in why the US has
the highest rate of maternal deaths in the developed world. Texas’s maternal mortality numbers have been
notably troubling, even as errors in
key data have complicated efforts to understand what’s going on and led skeptics, including the
governor,
to question whether there’s really a crisis.
Hardly anyone outside the policy world has taken a deep look at how these insurance gaps play out for women in the second-largest state in the US — at how, in the worst-case scenarios, lack of access to medical care endangers the lives of pregnant women, new mothers, and babies.
ProPublica and Vox have spent the past eight months doing just that — combing through government data and reports, medical records and research studies, and talking with scores of women, health care providers, policymakers and families of lost mothers around the state. We learned about Rosa Diaz and dozens of others, mostly women of color, by scouring medical examiner’s databases for sudden, “natural” deaths, then inspecting investigator and autopsy reports for clues about what went wrong.
The picture that emerges is of a system of staggering complexity, riddled with obstacles and cracks, that prioritizes babies over mothers, thwarts women at every turn, frustrates doctors and midwives, and incentivizes substandard care. It’s “the extreme example of a fragmented system that cares about women much more in the context of delivering a healthy baby than the mother’s health in and of itself,” said
Eugene Declercq, professor of community health sciences at Boston University School of Public Health.
Most of the mothers whose cases we examined were covered by Medicaid for low-income pregnant women, a
state-federal health insurance program that pays for
53 percent of the births in Texas, more than 200,000 a year, and
43 percent of all births nationwide. In Texas, the
program covers OB-GYN visits, medications, testing, and nonobstetric care, from endocrinologists to eye exams.
But the application process is so cumbersome that women in the state have the
latest entry to prenatal care in the country, ProPublica and Vox found. It can take months to be seen by regular providers and even longer to access specialists. This poses the greatest danger for high-risk mothers-to-be — as many women on Medicaid are, having had no medical care for significant parts of their lives. Then, roughly two months after delivery, pregnancy Medicaid comes to an end, and the safety net gives way to a cliff. For many new mothers, the result is a medical, emotional, and financial disaster.
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