House Committee Hears Testimony on Proposed National Legislation to Improve Maternal Health

Elizabeth Howell, MD, MPP, Director of the Blavatnik Family Women’s Health Research Institute, testifies before a House subcommittee

“The United States is the most dangerous place to deliver a baby in the developed world,” stated Congresswoman Anna Eshoo from California in her opening remarks at the House Committee on Energy and Commerce hearing in Washington on improving maternal health, quoting an investigation by USA Today from 2018.

Approximately 700 women die from a pregnancy-related cause each year. The United States maternal mortality rate is higher than other high-income countries, and the numbers are far worse for women of color. In addition, for every death, more than 100 women experience a severe complication related to pregnancy and childbirth, resulting in thousands of women every year experiencing one of these events according to the Centers for Disease Control and Prevention.

For these reasons, on Tuesday, September 10, Elizabeth Howell, MD, MPP, Director of the Blavatnik Family Women’s Health Research Institute and a Professor in the Departments of Obstetrics and Gynecology and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, testified before the Subcommittee on Health of the Committee on Energy and Commerce.

Click here to watch Dr. Howell’s testimony before the House subcommittee

Dr. Howell emphasized six important action items to improve maternal health, which included elements of four proposed bills that were discussed in the hearing:

1. Develop quality of care metrics for maternal health that are patient-centered and address disparities
2. Authorize the Alliance for Innovation on Maternal Health (AIM) program
3. Extend Medicaid to cover up to one year postpartum
4. Develop and expand perinatal care quality collaboratives
5. Provide support for training in implicit and explicit bias to all health care providers
6. Support infrastructure to improve data collection and measurement

We do not know yet whether these bills or parts of these bills will be passed and signed into federal law. But there are things that the government and the health care system can do and should implement in order to address the problem of maternal death in this country. Dr. Howell ended her testimony as follows: “We have to value pregnant women from every community. We can and must do better.”

In addition to Dr. Howell, Patrice Harris, MD, MA, President of the Board of Trustees of the American Medical Association; David Nelson, MD, Chief of Obstetrics at Parkland Health and Hospital System in Texas; Usha Ranji, Associate Director of Women’s Health Policy at the Kaiser Family Foundation; and Wanda Irving, mother of Shalon Irving, PhD, provided testimony on the four maternal health bills that the House of Representatives is considering. The proposed bills aim to improve access to care for pregnant and postpartum women and to reduce severe maternal morbidity and mortality. All five of these experts instructed Congress that there are concrete steps Congress can take to improve maternal care before, during, and after delivery.

Wanda Irving is the mother of Dr. Irving who died after childbirth despite multiple visits to health care providers in the three weeks postpartum before her death. In her testimony, Ms. Irving declared, “What infuriates me is that Shalon’s death was a preventable tragedy. She was a 36-year-old woman of color who went to her health care workers again and again in distress–and she was not properly treated.” Later in her testimony she added, “It should not have happened.” We must do better. We can do better.

The following four bills address varied aspects of health inequity and current shortfalls in our health care system that impact maternal health.

The Quality Care for Moms and Babies Act (H.R. 1551)

H.R.1551 proposes to identify and publish a recommended set of core maternal and infant health quality measures. The legislation calls for a list of recommended measures including standardized processes, experience requirements, and outcomes of maternity care (including postpartum care) across a variety of healthcare settings and health plans by January 1, 2021. Additionally, this list of recommendations must also address disparities in maternal care, care coordination, and the importance of shared decision making between the patient and provider. By January 1, 2022, these measures are to be published, disseminated, and applicable to all Medicaid and Children’s Health Insurance Program (CHIP) eligible patients. By January 1, 2023 the government will standardize reporting information based on the initial measures, and this reporting will occur by January 1, 2024 and every three years thereafter. H.R. 1551 also includes the following:

• Establish a Maternal and Infant Quality Program that publishes maternal and infant health quality measures that will inform future recommendations and research studies that develop and test evidence-based measures
• Establish the Maternal Consumer Assessment of Health Care Providers and Systems Survey to measure health care experiences.
• Annual State Reports of specific maternal and infant quality of care measures for those under Medicaid or CHIP
• Expand quality collaboratives that facilitate performance data collection and feedback reports to physicians on performance and achieving benchmarks, create protocols and checklists to foster safe evidence-based practice, translate evidence-based science into clinical care, and to evaluate quality improvement (QI) programs and projects.

The Mothers and Offspring Mortality and Morbidity Awareness (“MOMMA’s”) Act (H.R. 1897)

H.R. 1897 proposes mandating the submission of the United States Maternal Mortality Rate to the international data repositories, as the U.S. has not since 2007. Due to a lack of standardization across state maternal mortality review committees as well as the lack of 100 percent state reporting, data has not been sufficiently reported to the CDC for them to do a proper analysis. The bill discusses the danger of underreporting maternal mortality and morbidity and the racial disparities in maternal death in the United States. This legislation discusses maternal death in the postpartum period. According to the CDC report of maternal deaths from 2011-2015, 21 percent of maternal deaths occurs 7-42 days postpartum and nearly 12 percent of deaths occurred between 43 and 365 days postpartum. Additionally, this bill focuses on oral health—some evidence that suggests women with periodontal disease during pregnancy could be at greater risk for poor birth outcomes, including preeclampsia. H.R. 1897 also includes the following:

• Establish state-based perinatal collaboratives to work with hospital-based, outpatient, and clinical teams, experts, and stakeholders to spread best practices and optimize resources.
• Provide CDC support to states to report severe maternal morbidity, oral health, maternal health, and breastfeeding data back in a standardized manner.
• Extend Medicaid and CHIP to 1 year postpartum and expand to include oral health.
• Make resources for pregnant and postpartum women publicly available on the Department of Health and Human Services website.
• Establish an accreditation of Regional Centers of Excellence Addressing Implicit Bias and Cultural Competency for hospitals, health systems, medical schools, and other health services education institutions.
• Establish a special supplemental nutrition program for women, infants, and children up to 2 years postpartum via SNAP.
• Tax the tobacco industry to pay for the measures in this bill.

The Healthy MOMMIES Act (H.R. 2602)

H.R. 2602 proposes to improve maternal and child health outcomes, health equity, and communication by providers and integrate support services in maternal and infant care. A unique aspect of this bill is that it has a focus on primary care and doula care for Medicaid beneficiaries. H.R. 2602 includes the following:

• Extend Medicaid and CHIP up to 1 year postpartum, requiring oral health services for pregnant and postpartum women.
• Establish the Maternal Care Home Demonstration Project, a five-year project to reduce severe maternal morbidity and to reduce avoidable mother and infant rehospitalizations.
• Require the Comptroller General to submit report to congress on gaps in Medicaid in CHIP no later than one year after the passage of this act to create recommendations on how to improve gaps, especially for low income, women of color in health care shortage areas.
• Use telemedicine to increase access to maternity care and increasing access to doula care to Medicaid beneficiaries.

The Maternal Care Access and Reducing Emergencies (Maternal CARE) Act (H.R. 2902)

H.R. 2902 proposes to reduce severe maternal morbidity in the United States through better quality health care. However, the scope of this act would only include 10 states. Several measures that would be enacted by the passage of this act are:

• Provide Implicit Bias Training for Health Care providers. This would be done by federal grants to health professional schools, prioritizing disparities in OB/GYN care.
• Establish the Pregnancy Medical Home Demonstration Project to deliver integrated health care services to pregnant women and new mothers. A care manager would be assigned to each patient and each patient will have a standardized medical, OB exam, and psychosocial risk assessment at their first prenatal visit.
• Collaboration with the National Academy of Medicine to study and make recommendations for incorporating bias recognition in clinical skills testing for accredited allopathic and osteopathic medical schools.

Amy Balbierz, MPH, is a program manager in the Department of Population Health Science and Policy and for the Blavatnik Family Women’s Health Research Institute.