From the way the governor and top Republican lawmakers have been talking, you’d think the Legislature was taking bold steps toward solving the state’s alarming maternal mortality crisis.
“It is unacceptable that Texas continues to have a high rate of pregnancy-related deaths, but this upcoming special session presents us an opportunity to improve the situation,” said Representative Cindy Burkett, R-Sunnyvale, in June.
“Encouraged to see Texas House taking action on SB17 tonight. High maternal mortality rate is unacceptable and needs to be addressed,” Senator Charles Schwertner, R-Georgetown, tweeted on Sunday.
“As governor, I am committed to doing everything we can to combat the maternal mortality rate in this state,” Greg Abbott said on Wednesday.
But after a 140-day regular legislative session and a 30-day special session, all lawmakers managed to do was pass a couple narrow measures and continue a state task force that’s been studying the issue for nearly four years.
Extending the Maternal Mortality and Morbidity Task Force was never controversial. A similar measure during the regular session had only token opposition and was on the brink of passage until it was derailed by Lieutenant Governor Dan Patrick in a ploy to force a special session over the so-called bathroom bill. When the House debated Senate Bill 17, the task force legislation, on Sunday, lawmakers were so distracted that two female representatives had to ask for order four times in 10 minutes just to hear each other.
The task force was created in 2013 by the Legislature to study maternal mortality in Texas. The group, which is made up of medical professionals, did its work quietly, at least until an independent study in 2016 found that the rate of Texas mothers dying of pregnancy-related causes had doubled in two years and ranks the highest in the developed world. National outrage forced the Legislature to do something. Now conservatives are claiming credit for passing what health experts say is the bare minimum, while ignoring recommended policy changes that have already been identified by the state’s own researchers. It will likely be 2019 — eight years after the task force was first proposed in the Legislature — before lawmakers will have the next opportunity to address the crisis.
Researchers are not able to explain the troubling spike, and agree that further investigation is necessary. Lawmakers added language to clarify and expand the work of the task force this session, which they hope will allow the state to get complete data and better understand the problem. But advocates say that’s not enough.
“This research bill should be the beginning — rather than the end — of legislators’ work on this critical issue,” said Adriana Kohler, senior health policy associate at Texans Care for Children. “When the task force makes recommendations to reduce maternal mortality, we hope state leaders follow through on them for the sake of moms and families all over Texas.”
In 2016, the task force issued a report that offered lawmakers multiple recommendations to help mitigate the crisis. Foremost among the solutions: expand access to health care. Instead, both chambers let multiple bills that would do so languish in committee without so much as a hearing. Most of the proposals would cost money — anathema in the spending-averse Legislature.
One proposed measure would have extended Medicaid coverage for mothers a year after birth, rather than ending just 60 days after delivery. It failed to get a committee hearing. Another would have extended coverage for the first year, with a focus on postpartum depression treatment. It did not get a committee hearing. And another would have expanded coverage ahead of pregnancy by auto-enrolling individuals in the state’s low-income women’s health program when they age out of Medicaid or the Children’s Health Insurance Program (CHIP). It did not get a committee hearing.
“Getting the task force up to par was the first piece of the puzzle,” said Representative Shawn Thierry, D-Houston, who pushed Abbott to include maternal mortality issues in the special session. Her bill to investigate why African Americans are disproportionately likely to die of pregnancy-related causes was indiscriminately killed by the House Freedom Caucus. “But ultimately Texas needs to expand Medicaid so women can have full access to maternal care and health care. Until that happens, we’re going to have more challenges,” she told the Observer.
But Texas Republicans rejected a federally funded Medicaid expansion that would have covered 1.1 million more people, and are not likely to reconsider their decision soon. Experts point to the state’s refusal to expand Medicaid as a factor in problems with women’s health access. According to a new report, about one in four Texas women between the ages of 19 and 64 are uninsured, more than twice the national rate.
While Abbott and the GOP-controlled Legislature haven’t shown an appetite for expanding women’s health care, lawmakers have passed plenty of legislation that could make the problem worse. In June, Abbott unilaterally ended a bipartisan committee that advises Texas on women’s health and family planning programs, saying the state “should focus on programs that address more clearly identifiable needs.” This week, the governor signed three new anti-abortion bills into law, including one that critics say would force women with high-risk pregnancies to put off a medically-advised abortion until their life is in danger. The state’s sweeping new anti-abortion law during the regular session, which is already facing a legal challenge, was authored by Schwertner in the Senate and Burkett in the House.
This trend isn’t new. The Legislature in 2011 slashed family planning funding, forcing 82 clinics in the state to close. Texas kicked Planned Parenthood, the largest family planning provider, out of its low income women’s health program in 2013, leading to a 39 percent decline in women receiving health services from the program in the last five years. And the state is continuing to fight in court to ban Medicaid funding to Planned Parenthood.