Ned Barnett

To save more NC infants, expand Medicaid

With so many low-income people without health insurance, North Carolina has hundreds of thousands of reasons to expand Medicaid. Now here’s another: It could save the lives of infants.

A new report from NC Child funded by Community Catalyst and the Annie E. Casey Foundation focuses on North Carolina’s high infant mortality rate and how expanding Medicaid to low-income women could bring that rate down, especially for African-Americans and Hispanics.

When low-income women become pregnant, they are eligible for Medicaid. But the report stresses that delaying health insurance coverage until pregnancy is too late. Healthier babies come from healthier mothers, but uninsured women often suffer from preventable or manageable conditions such as obesity, hypertension or diabetes that complicate their pregnancies. The result is more low-birth-weight and premature babies who are at a greater risk of dying in their first year.

Even when they gain Medicaid coverage, pregnant woman who have been uninsured lack a regular doctor and may be unaware of how to engage with the health care system. In North Carolina, 31 percent of all births in 2014 were to mothers who did not receive prenatal care within their first three months of pregnancy. That means many don’t take crucial steps, such as taking folic acid to prevent serious birth defects of the spinal cord and brain.

Over the past two decades, progress in clinical care and the availability of Medicaid for pregnant women drove down North Carolina’s infant mortality rate by 40 percent. But that progress has plateaued in recent years, and the infant death gap between African-American and white babies has grown.

The language of the report describes the problem in stark terms. It says, “For every 1,000 babies born alive in North Carolina, seven will die in their first year of life.” With about 121,000 births annually, that rate translates into an average of three infant deaths per day.

North Carolina has the eighth-highest infant death rate in the nation, a status that report puts in startling perspective. It says, “A baby born in North Carolina is less likely to live to celebrate her first birthday than one born in the neighboring states of South Carolina, Virginia, or Tennessee. In fact, if North Carolina were a country, its infant mortality rate would rank among the poorest in the world, worse than Croatia and falling between Russia and Kuwait.”

In some North Carolina counties, the infant mortality rate is much higher than the state’s average of 7.1. Caldwell County is 14.5; Northampton, 18.2; Tyrrell, 24.4; Hertford, 31.4.

Part of what’s driving North Carolina’s poor infant mortality rating is the stubbornness of the state’s Republican leadership to expand Medicaid under the Affordable Care Act. Cost of the expansion to include between 300,000 and 500,000 low-income North Carolinians would be almost entirely paid for by federal dollars. But the General Assembly’s GOP leaders say North Carolina can’t take the risk of expanding the state-federal program because the federal government may one day cut its share of support or the state’s costs could rise in the future. The real reason, of course, is they want nothing to do with the signature program of President Barack Obama.

That phony savings is coming at a high cost to the health of low-income women and their babies. In North Carolina, one in every five women of reproductive age is uninsured. Most of them lack regular access to health care. That’s a serious gap because, the report notes, “37 percent of North Carolina women between the ages of 18 and 44 suffer from one or more chronic health conditions, placing their babies at higher risks of pregnancy complications, preterm births and low birth-weight.”

Some state lawmakers have talked a great deal in recent years about protecting the health and welfare of children. They’ve cited that protection in justifying House Bill 2, new restrictions on abortion and even vouchers so children from low-income families can attend private schools. But that concern rings hollow when it’s paired with a refusal to expand Medicaid.

Thirty-one states have expanded Medicaid. Their economies and the health of their people have benefited from it. In North Carolina, taxpayers are funding the expansions elsewhere while their own state passes up billions of federal dollars that could create jobs and reduce preventable and treatable conditions that raise health care costs when they become chronic.

As the NC Child report concludes: “Medicaid expansion holds tremendous potential to improve birth outcomes and reduce longstanding racial and ethnic disparities by improving access to care and promoting the health of women.”

During this campaign season, as state lawmakers and the governor are out kissing babies, they ought to realize they can save future ones. All it will take is a simple vote to expand Medicaid.

Barnett: 919-829-4512,