Thread by @juliaoftoronto

**TWEETORIAL** It's well known the US has some of the worst mater maternal health outcomes among high-income countries.

Less well known: How inextricably linked those deaths and illnesses are to America's f*cked up health insurance system. 1/

vox.com/science-and-he…

@ByNinaMartin and I spent the better part of last year looking closely at Texas — the state with the worst rate of insurance coverage in the US.

Texas’ uninsurance rate isn’t just higher than other states’ — it’s astonishingly higher. 2/

At least 382 pregnant women and new mothers died from causes related to pregnancy and childbirth between 2012-2015.

Thousands more got sick, nearly died, or had emotional & financial traumas related to preg/childbirth. 3/

To understand how the abysmal insurance rates and poor maternal health outcomes are linked, we combed autopsy reports, government data, medical records and talked with scores of women, health care providers, policymakers and families, etc. 4/

We heard stomach-turning stories of new moms who rationed care when they were sick because they didn't have insurance.

They died as a result.

Far more often... 5/

We heard how difficult it was to navigate a staggeringly complicated insurance system, to do the very basic things necessary to have a healthy pregnancy... 6/

Simple things, like signing up for pregnancy Medicaid -- which covers less than half of all births nationwide and more than half in Texas.

It's really, really hard.

It's no accident that women in TX are later to prenatal care than they are in the rest of the country. 7/

The Medicaid application itself is 32 pages long.

Women need to provide all kinds of proof they qualify.

It can take weeks or even months to an app together and get enrolled.

yourtexasbenefits.com/GeneratePDF/St… 8/

This at a time when other states have made it a priority to drastically reduce or eliminate sign-up delays. Oklahoma, for ex., approves 100 percent of Medicaid applications by pregnant women instantly; verifies them later.

45 states and DC consider apps within 24 hours. 9/

This lateness, and lack of insurance before pregnancy, compounds; it means, for ex, moms with chronic conditions are less likely to have them under control when their babies' organs are developing, and they're more likely have a premature birth... or get sick in pregnancy. 10/

According to the most recent report of the Texas maternal mortality review task force, preexisting health problems are the most common contributing factor to maternal death in the state. When they're uncontrolled, they're deadly. 11/

dshs.texas.gov/mch/Maternal-M…

Pregnancy Medicaid also only lasts 60 days postpartum, so women face an insurance cliff shortly after they give birth.

Yet, it's well known that the two-month mark can be a “tipping point," @neel_shah said. 12/

Over and over again, Texas has made policy choices that amount to not addressing these problems for moms — to making them worse. They've prioritized fetuses and babies over moms.

The most breathtaking example of that is the CHIP Perinate program... 13/

... The program, which mostly covers immigrants, doesn’t actually cover the mother... just the fetus she is carrying. 🤯🤯14/

hhs.texas.gov/services/healt…

So... many women are left to fend for themselves, to find their own stopgaps.

One mom w/ diabetes told us this meant rationing her insulin in pregnancy so she'd have some leftover later to be healthy enough to care for her newborn when she lost insurance... 15/

Another mom scrambled to get a gallbladder surgery right after her c-section, even though she hadn't healed, so she could squeeze it in before her Medicaid ran out.... 16/

Another lied her way into a county health programs to get care for a pregnancy-related complication that surfaced just before her pregnancy Medicaid expired. 17/

These stories were devastating. They are preventable and fixable with policy. I'm seeing it first hand now living in Vienna (Austria)... 18/

I'm pregnant now too. And going to the doctor for prenatal care, which I'm very lucky to access, always involves getting my "mutter kind pass" — mother child passport — filled out by the doctor. It's like a passport for pregnancy care, and... 19/ geburtsinfo.wien/en/vor-der-geb…

And the end of the pregnancy, moms send the passes into the government. If they've met the requirements for prenatal care, they're eligible for state benefits for their babies. 20/

Of course, Austria also has universal health care. But it's not an accident that it has some of the best maternal health outcomes in the world. 21/