By Sarah Smith, ProPublica

This story was originally published by ProPublica.

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When it comes to reproductive care, Mississippi has a dual distinction. The state spawned the law that likely will lead to the Supreme Court striking down Roe v. Wade. It is also unique among Deep South states for doing the least to provide health care coverage to low-income people who have given birth.

Mississippians on Medicaid, the government health insurance program for the poor, lose coverage a mere 60 days after childbirth. That’s often well before the onset of postpartum depression or life-threatening, birth-related infections: A 2020 study found that people racked up 81% of their postpartum expenses between 60 days and a year after delivery. And Mississippi’s own Maternal Mortality Review Committee found that 37% of pregnancy-related deaths between 2013 and 2016 occurred more than six weeks postpartum.

Every other state in the Deep South has extended or is in the process of extending Medicaid coverage to 12 months postpartum. Wyoming and South Dakota are the only other states where trigger laws will outlaw nearly all abortions if Roe falls and where lawmakers haven’t expanded Medicaid or extended postpartum coverage.

“It’s hypocrisy to say that we are pro-life on one end, that we want to protect the baby, but yet you don’t want to pass this kind of legislation that will protect that mom who has to bear the responsibility of that child,” said Cassandra Welchlin, executive director of the MS Black Women’s Roundtable, a nonprofit that works at the intersection of race, gender and economic justice.

Efforts to extend coverage past 60 days have repeatedly failed in Mississippi — where 60% of births are covered by Medicaid — despite support from major medical associations and legislators on both sides of the aisle.

Mississippi House Speaker Philip Gunn, a Republican, said shortly after he killed the most recent bill that would’ve extended postpartum coverage that he’s against expanding any form of Medicaid. “We need to look for ways to keep people off, not put them on,” he told The Associated Press in March. When asked about the issue during a May 8 interview on CNN, Mississippi Gov. Tate Reeves said, “When you talk about these young ladies, the best thing we can do for them is to provide and improve educational opportunities for them.” (Neither Gunn nor Reeves responded to requests for comment.)

During the pandemic, a change in federal rules prevented states from cutting off Medicaid recipients, which has allowed people in Mississippi and elsewhere to retain postpartum coverage beyond 60 days. But at the end of the federal public health emergency declaration — which is set to expire in July 2022 — states will revert to their prior policies. “What we are afraid of is that when that does end, it will go back to what we knew was pre-pandemic health care,” Welchlin said.

We discussed the implications of Mississippi’s post-Roe reality with Welchlin and two other experts in the field: Alina Salganicoff, the Kaiser Family Foundation’s director for women’s health policy, and Andrea Miller, president of the National Institute for Reproductive Health. Their answers have been lightly edited for length and clarity.

What services does Medicaid provide postpartum?

Salganicoff: Typically, everything from assistance if the person is having problems breastfeeding to screening for depression services.

Welchlin: We know the struggles of so many who have had life threatening illnesses such as heart conditions and hypertension. We know of course that Medicaid helps in that.

What have you seen in terms of postpartum needs in Mississippi?

Welchlin: One of the stories that really touched me over the course of this pandemic was that of a mom who already had a child, and she needed access to child care so she could get back and forth to the doctor. During this particular pregnancy she had a severe heart disorder where she couldn’t breathe, and she had to get rushed to the hospital. Because she was so connected to doulas and a supportive care organization like us, she was able to get admitted and sure enough that’s when they diagnosed her with that heart condition. And she was a mom on Medicaid.

What happens when mothers lose Medicaid coverage postpartum?

Miller: Only giving someone two months postpartum doesn’t allow for the kind of continuation of care that you need. If there are indications of problems in the postpartum period, they don’t all necessarily show up within the first two months. And we certainly know that the ability to have a healthy infant and keep an infant healthy is also related to whether you have coverage. The extension to 12 months really allows for that kind of continuum of care.

Welchlin: We know in the state of Mississippi, women die at higher rates, and of course it’s higher for Black women. And so, when women don’t have that coverage, what happens is they die.

What does it mean to not extend postpartum Medicaid coverage if Roe falls?

Miller: These bans on abortion are going to be layered on top of an already-unconscionable maternal and infant health crisis that most particularly impacts those who are struggling to make ends meet. It particularly impacts Black women and other communities of color. … A state like Mississippi that is so clearly wanting to ban abortions — the fact that they refuse to extend basic health care benefits that will help during pregnancy and postpartum just clearly indicates that they are not interested in the health and well-being of women and families and children, that they are purely on an ideological crusade.

Anything else that you wanted to add?

Salganicoff: We’re very focused on that first year of life. But if you’re speaking about a woman who is not going to be able to get an abortion that she seeks and ends up carrying the pregnancy, the supports that she’s going to need and her child is going to need go far beyond the first year of life.

Miller: You can’t have a conversation about legality or soon-to-be illegality of abortion in these states and not have a conversation simultaneously about the existing crisis around maternal and infant health. These things are all interconnected, and that’s why it is so deeply disturbing that the states trying to ban abortion are the same states that are refusing to expand Medicaid under the ACA, that are failing to take advantage of the ability to extend postpartum [coverage] by 12 months, that don’t invest in child care, that don’t invest in education — these are all part of the same conversation.

Welchlin:Audre Lorde said, “There is no such thing as a single-issue struggle because we do not live single-issue lives.” So, abortion access, reproductive justice, voting rights, racial justice, gender equity — these are not separate issues, they are intersecting issues that collectively determine the quality of our lives.