Why Utah moms could see new health care and benefits this year

The Legislature is considering bills that would expand Medicaid for pregnant people and allow additional benefits by counting a fetus as a child.

(Trent Nelson | The Salt Lake Tribune) Michelle Debbink at her home in Salt Lake City on Thursday, Feb. 2, 2023.

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Telling a young father with an eight-month-old cradled on his hip that his partner has died due to pregnancy-related complications is “soul-crushing,” said Dr. Michelle Debbink.

Informing someone that their loved one is gone is never easy. For Debbink, a physician and researcher at the University of Utah, the fact that the deaths of young mothers are also often preventable, adds another level of pain. She sees the harm those deaths have not only on children, but on whole communities.

“We’re tearing apart our social fabric and it’s hard to watch that,” Debbink said. “We know that there were opportunities to have the story turn out differently.”

Debbink testified before the Social Services Appropriations Subcommittee on Wednesday morning in support of a measure she believes could help low-income moms get the care they need.

With an abortion ban looming, lawmakers are considering several bills aimed at “supporting life,” as Republican Gov. Spencer Cox outlined in his State of the State address. He is pressing lawmakers to pass measures that would benefit “both the born and the unborn,” he told Utahns.

Some bills in front of the Legislature — like the one Debbink spoke in support of — would lengthen access to health care for pregnant women after birth. Others would award those women additional benefits by recognizing a fetus as a person — a move critics argue could come at a cost to mothers.

Expanding access to health care

Debbink testified that morning in support of legislation extending Medicaid coverage for new mothers. “Knowing that we have a treatment and knowing that we struggle to offer it is really devastating,” she told The Salt Lake Tribune.

One of Rep. Rosemary Lesser’s, D-Ogden, priorities this session is to help more pregnant women afford health care.

(Francisco Kjolseth | The Salt Lake Tribune) Representative Rosemary Lesser, D-Ogden is joined by Rep. Judy Weeks Rohner, R-West Valley City, as they hold a news conference on the steps of the Utah Capitol on Tuesday, Feb. 1, 2022, to bring attention to legislation they are bringing forward aimed at eliminating the state’s portion of the sales tax on food.

Lesser, also a physician, is sponsoring two bills aimed at improving health care for new moms before and after they give birth. This is the second year she’s proposed both expanding the pool of pregnant women eligible to receive Medicaid and extending coverage for postpartum moms from 60 days to 12 months.

“I proposed these bills last year before the Dobbs decision because I was committed to elevating health care for Utah families,” Lesser said.

In 2020 Medicaid paid for roughly 22% of births in Utah.

Currently, Utah caps eligibility at roughly 138% of the federal poverty level, with “a little bit of a bump” for pregnant mothers, Lesser explained.

“The reality is a single woman who is pregnant, who makes more than $9.50 an hour makes too much money to qualify for Medicaid in our state,” Lesser said. That puts low-income mothers in a tough place — they must decide whether to quit their jobs to access health care or may just choose to forgo prenatal care, according to Lesser.

HB85 would raise the income threshold to 200% of the federal poverty line.

Postpartum care for more than 60 days

Symptoms like diabetes and depression can develop during pregnancy and may require treatment long after a baby is born. “High blood pressure in pregnancy can go away,” Lesser said. “Or it can be a marker of an ongoing problem that can impact a person’s kidney function and heart function for decades to come if not treated. That’s why I think a year [of Medicaid coverage] is important.”

Medicaid only covers women for 60 days after giving birth, although during the pandemic federal law prohibited states from disenrolling recipients. That pandemic-driven benefit is slated to sunset soon, and when it does, the Kaiser Family Foundation estimates somewhere between 5 million and 14 million people will lose Medicaid coverage.

States, however, can choose to lengthen postpartum Medicaid coverage from the standard two months after birth to a full year.

“Having a baby changes people’s lives,” Debbink said. “It’s stressful and it creates a whole new normal.” Managing heart failure, high blood pressure or mental health conditions on top of those changes is tough for new moms and Debbink would like it to be a little easier.

“Access to insurance is a key and critical piece of that,” said Debbink. “It’s not the only answer, but it is a critical piece.”

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So far, 29 states have implemented the 12-month extension and six others are planning to. Some states, like Texas, approved the extension but only up to six months rather than twelve.

Lesser’s HB84 would create a longer window of health care coverage in Utah. Sen. Wayne Harper, R-Taylorsville, is also sponsoring a similar bill, SB133, to extend coverage.

The Utah Perinatal Mortality Review’s report on pregnancy-related deaths found that between 2015 and 2016 about 92% of maternal deaths in the state were preventable. Over half of the maternal deaths in Utah, they found, occurred between 45-365 days after giving birth.

(Jeffrey D. Allred | Pool) Gov. Spencer Cox greets Sen. Daniel McCay, R-Riverton, and Sen. Chris Wilson, R-Logan, as he enters the House of Representatives for his 2023 State of the State address to the legislature at the Capitol in Salt Lake City on Thursday, Jan. 19, 2023.

Lesser wants to enhance coverage so that from conception to a year after birth, both mother and baby are on “a path of good health for the rest of their lives.” And the governor is on board.

As part of his fiscal year 2024 budget, Cox recommended the Legislature invest $8.7 million in providing pregnant women on Medicaid with one year of continued postpartum care.

Expanding personhood

Cox is also asking lawmakers to give a tax credit — an estimated $4.5 million in total next year — to expectant mothers in the year they give birth to a child to “provide financial relief.” So, in the woman’s tax return, the unborn fetus would be counted as a child.

Rep. Karianne Lisonbee, R-Clearfield, is sponsoring the bill as it moves through the Legislature. As of Wednesday afternoon, it has yet to move past the House’s first reading calendar and into committee.

Lisonbee did not grant The Tribune’s request for an interview, nor did she respond to questions sent over email prior to publication of this piece.

Since the overturn of Roe v. Wade — which held that “the word ‘person,’ as used in the Fourteenth Amendment, does not include the unborn” — last summer, numerous states have tried to put in place so-called “personhood” laws. Thus, expanding the legal concept of a child to a fetus.

Among the most expansive is Georgia’s 2019 abortion ban, under which parents can also claim a fetus as a dependent when filing taxes. Other states have passed laws to establish fetal personhood, but many have been held up in court or, in Kansas’ case, voted down.

Most other attempts at establishing personhood, unlike Lisonbee’s, are wrapped into abortion laws. But critics argue that regarding a fetus as a child in less controversial laws could lead to the criminalization of pregnant people down the road.

Dana Sussman, acting executive director of Pregnancy Justice, a legal advocacy group for pregnant women’s rights, said there are better ways to make pregnant women’s lives easier.

“States that profess to care about women, children, and families would be far more effective in supporting them by expanding prenatal care, improving access to midwives and doulas, expanding Medicaid access, and passing paid family leave,” Sussman wrote in an email.

Lisonbee, who was the House sponsor of Utah’s abortion trigger ban in 2020, isn’t the only lawmaker this session who is introducing a bill that would give a fetus personhood.

(Trent Nelson | The Salt Lake Tribune) Rep. Stephanie Gricius in a meeting of the House Health and Human Services Standing Committee, in Salt Lake City on Wednesday, Feb. 1, 2023.

Pregnant people would be allowed to drive in carpool lanes if a bill put forward by Rep. Stephanie Gricius, R-Eagle Mountain, passes. At a committee meeting Monday in which the bill was discussed, Gricius said she introduced it for two reasons — because it’s “life-affirming” and because “being pregnant is hard.”

“As we move away from abortions here in Utah, this is a cost-free way to also just kind of say to the ladies in the room, we see you,” Gricius said.

Everyone who spoke in favor of the bill during public comment is involved in conservative groups that take anti-abortion positions. One person spoke against the bill, saying it doesn’t go far enough to establish personhood.

“We know that an unborn child is a human being,” said Mary Taylor of Pro-Life Utah, who stood up in support of the bill at the meeting. “And we think that as a society, we ought to be counting that human being as a human being from the start. And so we are definitely in favor of that.”

Gricius told The Tribune that a fetus’ personhood is already on the books in Utah’s criminal code, so her bill wouldn’t be the only one to recognize a fetus as a second person.

Utah Code defines criminal homicide as “an act causing the death of another human being, including an unborn child at any stage of the unborn child’s development.” It makes an exception for abortions or for deaths a judge determines are unintentionally caused by the mother.

The bill passed favorably out of committee last Monday. Five Republicans and one Democrat voted for it, while one Democrat and two Republicans voted against it. It then passed out of the House on Friday with a 49-23 vote, again with both Democrats and Republicans opposing it.

Lawmakers in Texas are considering a similar bill, which was prompted by a woman who, citing the state’s abortion ban, challenged a ticket she received for driving in a carpool lane while pregnant.

Abortion rights advocates argue personhood laws could impact women beyond abortion access — it could make in vitro fertilization more difficult by granting rights to embryos, could subject pregnant people to child endangerment laws or could impact their ability to make unrelated personal health care decisions.

“You’re not encouraging carpooling by giving pregnant women the opportunity to drive in the HOV lane, what you’re doing is you’re normalizing this idea that she is not her own person,” Sussman said.

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