Combating Maternal Mortality: Q&A with the Health Care Service Corporation (HCSC)

Modern Medicaid Alliance (MMA): What is HCSC and who do you serve? 

Gloria Eldridge (HCSC): The Health Care Service Corporation (HCSC) is the largest customer-owned health insurer in the United States. We operate 5 Blue Cross and Blue Shield® Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. Founded in 1936, we employ nearly 24,000 people, ensure more than 17 million members, and administers $80 billion in health care goods and services. 

We have a longstanding commitment to health equity, ensuring people have opportunities to improve their health outcomes through access to quality, affordable health care. In the Medicaid space, we cover nearly 1 million members in Illinois, New Mexico, and Texas. We offer a broad array of services to this population including medical services, long-term services and supports, and medically related social services.  

MMA: What role has HCSC played in advocating for enhanced postpartum coverage in Medicaid and CHIP? 

HCSC: In the past, Medicaid has only allowed 60 days postpartum coverage for pregnant people. In 2018, HCSC made a commitment to advocate for coverage through one year postpartum where the state had the option to participate. 

We actively advocated on Capitol Hill. Then, the Helping Moms Act was introduced by Representative Kelly of Illinois. It was co-sponsored by Representative Underwood of Illinois and Representative Burgess of Texas, among many others. We have partnered with several health plan associations and health plans to reduce maternal mortality and reduce disparities in maternal mortality. Provider and patient groups have been central to this effort. 

Allowing states the option to cover mothers in Medicaid through 12 months postpartum will substantially improve access to care for our members and tens of thousands of mothers across the country. 

MMA: Describe the impact and importance of continuing Medicaid coverage to 365 days postpartum for reducing maternal mortality? 

HCSC: We need the Helping Moms Act to reduce maternal mortality. The U.S. has the highest rate of maternal mortality of any developed country – maternal mortality is measured by deaths within one year from the end of a pregnancy.  

In 2018, the maternal death rate in many European countries and Canada was below 9 per 100,000 live births, compared to the U.S. rate of over 17 per 100,000 live births. Under 9 compared to over 17 – nearly twice the number. 

An important study looked at if having health care coverage reduced maternal mortality, which is similar to what would happen if the Helping Moms Act became law. In the study, health care coverage was significantly associated with 7 fewer maternal deaths per 100,000 live births in coverage versus non-coverage states. 

We believe the Helping Moms Act will have the same effect. We believe the Helping Moms Act will reduce maternal mortality. 

MMA: Describe the importance of the Helping Moms Act for reducing disparities in maternal mortality. 

HCSC: We need the Helping Moms Act to reduce disparities in maternal mortality. In the U.S., disparities in maternal mortality by race and ethnicity are pronounced. The following data is from the Centers for Disease Control [and Prevention] (CDC) for the years 2014 through 2017. 

  • White non-Hispanic women experienced 13 deaths per 100,000 live births. 
  • Black women had 42 deaths per 100,000 live births — This is more than three times the number.  
  • American Indian and Alaskan Native women had 28 deaths per 100,000 live births. 
  • Asian and Pacific Islander women had 14 deaths per 100,000 live births. 
  •  And Hispanic women had 12 deaths per 100,000 live births. 

There was an important study that looked at effects on disparities of coverage versus non-coverage. In that study, there were 16 fewer maternal deaths per 100,000 live births for black women when they had access to health care coverage. For Hispanic women, the study found 6 fewer deaths per 100,000 live births. 

The Helping Moms Act will increase coverage. The Helping Moms Act will reduce disparities in maternal mortality. 

MMA: What successes have you seen in extending postpartum coverage? 

HCSC: In September 2020, the U.S. House of Representatives passed the Helping Moms Act unanimously. In the American Rescue Plan of 2021, HCSC and all of our partners saw the 12-month postpartum provision passed by Congress in a time-limited 5-year program. This Congress, the Helping Moms Act has been reintroduced. 

Throughout these years, we have also closely watched applications for state Medicaid waivers that would provide similar coverage. We strongly advocated at the federal and state level for approval of the Illinois waiver. It was approved in the Spring of 2021 and was the first waiver of its kind. 

Congress should enact the Helping Moms Act. This would allow a permanent state option that is not time-limited for 12-month postpartum coverage. This was our original intent and we plan to see it through. 

MMA: What more should be done to protect new and expectant mothers and their babies? 

HCSC: Congress should pass the Helping Moms Act, legislation that is not time-limited to allow states at their option to extend Medicaid coverage to 12 months postpartum. This legislation is already bipartisan. In September 2020, it passed the U.S. House of Representatives unanimously.  

The Helping Moms Act would greatly improve health equity, reduce maternal mortality, reduce disparities in maternal mortality, and improve outcomes for our members and for tens of thousands of mothers across the country.  

 

Dr. Gloria N. Eldridge, PhD is the Medicaid and CHIP policy lead and the health equity policy lead at the Health Care Service Corporation. She represents all five of HCSC’s health plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. For HCSC, she also leads other health policy areas, including disabilities, telehealth, and quality of care. She has twenty-five years of experience spanning various organizations, including international agencies, academia, think tanks, government, multi-national corporations, and consulting firms. She has represented HCSC in Medicaid policy for eight years, nearly the entire time the company has offered Medicaid managed care organizations (MCOs). She has authored or contributed to more than thirty publications and wrote her doctoral dissertation on national health reform and the Medicaid program. Most of her publications are on re-organizing financing in the health care system, value based health care, or quality of care in long term care settings.