Imagine a situation in which a young woman with advanced degrees and solid work history receives a diagnosis of type 2 diabetes, but because she’s in between jobs, she’s unable see a doctor and get the medication she needs to treat her disease.

Unfortunately, Michaela Penix’s story isn’t unique or uncommon in North Carolina. While a growing number of states are expanding access to care and closing health care coverage gaps, nearly one in every six women of childbearing age in North Carolina had no health insurance in 2017, putting us near the bottom of national rankings.

For March of Dimes and NC Child, that is simply unacceptable. We understand that the health of moms and babies is powerfully linked, before, during, and after pregnancy. If mom isn’t healthy, then baby is at higher risk for a whole host of health consequences. But if mom is healthy, that baby has a much higher likelihood of getting the best possible start in life.

For low-income woman between the ages of 19 and 44 in the state, options for health insurance coverage are very limited. A woman isn’t eligible for Medicaid unless she’s pregnant, at which point she’s already forfeited the best opportunities to help her have a healthy pregnancy. Non-pregnant women can obtain coverage through a Marketplace plan, but those earning less than 100% of the federal poverty level aren’t eligible for tax credits to help offset costs. Additionally, Marketplace insurance plans may come with deductibles, co-payments and other cost-sharing that make it impossible to afford. As a result, too many North Carolina women of reproductive age remain uninsured and unprepared for a serious medical event.

This situation is untenable not only for women, but for their babies as well. The infant mortality rate for black babies in North Carolina at 12.5 per 1,000 live births is more than twice the rate for their white counterparts. States that have closed their coverage gap have reported a 50% drop in infant mortality rates as compared to states that did not, according to the Georgetown University Center for Children and Families. If a woman can obtain regular health care services to help quit smoking, achieve a healthy weight and maintain normal blood pressure and blood sugar levels, she is much more likely to have a healthy pregnancy and baby.

Taking action now also makes great fiscal sense. Medicaid covers more than half of all births, and first-year medical costs, including both inpatient and outpatient care, are about 10 times greater for preterm infants ($32,325) than for full-term infants ($3,325) nationally. Based on these estimates, we would save about $29 million in first-year medical costs for every 1,000 fewer babies born preterm. Additionally, access to preconception and prenatal care are critical to reducing the risk of complicated births, which account for a large proportion of maternity and newborn care expenses.

If we’re serious about expanding health care to more people, we cannot create new barriers to access such as harmful work requirements. Instead, we must focus on improving, not limiting, access to vital health care services. That includes extending eligibility for low-income individuals to 138% of the federal poverty threshold and ensuring women are able to access health care throughout the prenatal and postpartum periods for 12 months after giving birth. Gaps in coverage could cause them to miss important medical appointments and receive services critical to their health and that of their baby.

Fortunately for Michaela, she was eventually able to get a Marketplace plan through the Affordable Care Act to keep her healthy. Let’s act now to close the health care coverage gap so no one else has to forgo the care they need. Expanding Medicaid coverage is a sensible, cost-effective solution that will protect the lives of women and their babies, and create a stronger, healthier North Carolina.

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Dr. Rahul Gupta is senior vice president and chief medical and health officer at March of Dimes. Tom Vitaglione is senior fellow, Health and Safety, at NC Child.

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