Lack of Medicaid Coverage In Texas Leaves Thousands of Pregnant Women Uninsured

Supermajority Education Fund

December 10, 2019

A new investigation by ProPublica and the Texas Tribune highlights the “patchwork of services” uninsured pregnant women in Texas have to rely on when they seek care — and the dangerous consequences these women face when that coverage fails to meet their needs. 

As journalists Julia Belluz and Nina Martin note in the investigation, Texas has one of the highest rates of uninsured people in the country, and the numbers are particularly bad for women of childbearing age, with about a third being uninsured. The impact of that lack of access to care is often deadly. Belluz and Martin report that the state saw at least 382 pregnant women and new mothers die from pregnancy or childbirth-related causes between 2012 and 2015.

While these cases “reflect the problems that contribute to maternal mortality across the United States — gross medical errors, deeply entrenched racism, structural deficiencies in how care is delivered — another Texas-size factor often plays a significant role: the state’s vast, and growing, problem with health insurance access,” Belluz and Martin wrote.

Kami Geoffray, the chief executive officer of the Women’s Health and Family Planning Association of Texas, told Supermajority News that “Texas is one of the states with the most restrictive eligibility requirements when it comes to Medicaid.” While some pregnant patients do get access to Medicaid and care through Texas’s Children’s Health Insurance Program (CHIP), Geoffray explained, other options are “very limited.” 

One of the consequences for women who lack health insurance is that many of them do not end up enrolling in Medicaid until their second trimester or later. “We have the latest rate [of pregnant women enrolling in Medicaid] in the country,” said Geoffray of Texas. 

One common reason for this delay, Geoffray added, is the fact that Texas no longer allows a woman to self-determine her pregnancy. This means that she has to be examined by a medical practitioner and diagnosed as pregnant before being eligible for Medicaid. Appointment wait times could mean that critical weeks go by without health care coverage. “That means there are missed opportunities to treat people in the first trimester or ideally before they are pregnant, Geoffray said.”

“A lot of the time there are policy considerations made without thinking about what it means to live in poverty in Texas,”  Geoffray added, noting that a lack of transportation access, a need for child care and the need to take time off work all play a factor in delaying a pregnant woman’s ability to pursue care. “We sometimes fail to acknowledge the barriers that are already in place for people living in poverty without even thinking about the complexity of the healthcare system we are asking people to navigate.”