In Joe Biden’s first speech as president-elect, he thanked Black voters for standing with him and promised to always have their backs. Many Black voters across the country are celebrating the election of Biden and Kamala Harris, but we are also eager for action on their campaign promises of addressing the country’s vast inequalities and systemic barriers. And we know that especially now, with COVID-19 disproportionately affecting communities of color, we cannot have any conversation around racial justice without addressing the racial health disparities that permeate our health care system. Congress and the new Biden-Harris administration must work together to uproot these underlying racial inequities, and they should start with our community’s maternal and prenatal health care outcomes.
Recent data from the U.S. Centers for Disease Control and Prevention indicate that the Black maternal mortality rate is more than double the rate for white women. The Black infant mortality rate is also more than double the rate of non-Hispanic white infants. These differences may stem from inequalities experienced during post-pregnancy coverage and care, but unfortunately, disparities in coverage begin to appear at the earliest stages of a pregnancy. Focusing on root causes, like this prenatal care period, is the best first step down the road of eliminating racial disparities.
Prenatal screening tests exemplify these disparities. Critical to ensuring a mother’s healthy pregnancy, these screenings include testing that helps pregnant women identify genetic disorders in their babies. Newer screening options called noninvasive prenatal tests have been proven to give more accurate results than traditional testing methods, but the sad reality is Black women in this country have less access to these superior testing options: Data recently published by the California Department of Public Health revealed that white women who opted out of the state-funded prenatal screening program were more than twice as likely to gain access to NIPT as Black women (39 percent to 17 percent).
Many factors could be contributing to this disparity, but one known cause is inadequate health insurance coverage of NIPT. Even as professional medical associations like the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine have issued guidelines recommending NIPT for all pregnant women, some large private insurers continue to refuse to cover NIPT for all pregnant women. Further exacerbating the coverage problem, NIPT is currently unavailable through Medicaid for some women in 37 out of 50 states, and it is not covered for any women in nine of these states.
While we are all heartened by the increased conversations around racial justice and racial disparities within our health care system, we need the federal government to step up and directly address issues like maternal and prenatal care with the urgency they deserve.
The newly elected 117th Congress can begin by passing the Black Maternal Health Momnibus Act of 2020 (“Momnibus”). Led by Vice President-elect Kamala Harris alongside Reps. Lauren Underwood and Alma Adams, the Momnibus directly addresses every dimension of the Black maternal health crisis in America – including inequities in prenatal care – by making investments in social determinants of health, the diversification of the perinatal workforce, and improvements in digital tools like telehealth. Congress can also federally mandate NIPT coverage in Medicaid for all pregnant women, as a bill introduced in early October would accomplish, and amend the Cures for the 21st Century Act (CURES 2.0) to include policies that improve access to high-quality maternity care for women and their babies.
Increasing accessibility to safer and more effective maternal and prenatal care options like NIPT to all pregnant women is an immediate step we can take to tackle one of the systemic factors that have plagued our health care system for so long. And while we were encouraged to see 35 California lawmakers in September sign onto a letter calling for Aetna and UnitedHealthcare to permanently cover NIPT for all pregnant women, there is still much work to be done on the federal level in 2021 if we are aiming for true racial justice in this country.
Felica Jones is the CEO and Executive Director of Healthy African American Families, a nonprofit organization dedicated to improving health outcomes for minority communities.
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