Pre-Eclampsia and Heart Disease: Why We Need Medicaid Expansion

Common wisdom about pre-eclampsia seems to be that it ends after pregnancy.  Most people know pregnancy hypertension means you need to get the baby out before mom’s blood pressure spikes even more.  Because it is usually successfully treated, I’ve heard people say that it’s “no big deal”.  Still, between 5 and 8% of births in the U.S. were the result of a pregnancy complicated by pre-eclampsia.  Likewise, The Pre-Eclampsia Foundation estimates that 76,000 moms and half a million babies die annually from the disease.  This is a serious complication and it doesn’t always just “go away”.

Many women experience high blood pressure even after they deliver their babies.  I have two good friends who have experienced long-term complications from pre-e.  One cannot exercise and relies on a beta blocker to keep her BP normal.  Her child is now in school and this has not changed.  She worries if she has another child, it will come sooner than her pre-term birth with her first child and she will have pre-e again.  Prior to knowing my friends’ struggles I believed that pre-e was a complication we had all but “taken care of”.  I now know, however, that it can have long-term effects.

Thus, when one of these friends posted an article from NPR about the link between blood pressure complications in pregnancy and heart disease later in life, I took note and shuddered as I read it.  We now know that women are up to 8 times more likely to contract heart disease after these complications in pregnancy.

Heart disease is already the number one cause of death in women in the United States.  This link could be an important piece in targeting the women most at risk for its development later in life.

While pre-eclampsia isn’t exclusive to women who have fewer resources (both of the women above are highly educated and have good access to health care), it is more likely to occur in women with lower levels of income and education.  The Generation R Study is often-cited as an important piece of evidence which suggests that targeting these populations with better care may reduce the incidence of this disease.

I don’t know that public policy can solve this issue but I can see that it could help address problems. In a week where the Republican Congress is grappling with how to “fix” Obamacare, it seems important to mention that the women most at risk for developing high blood pressure in pregnancy and, thus, heart disease in later life, are those most at risk for losing their insurance as a result of changes to health policy in the U.S.

Women who are of a lower socioeconomic status (SES) are more likely to rely on Medicaid for their insurance needs and Medicaid is at great risk with these proposed policy changes.  While many women qualified for pregnant women’s Medicaid, fewer women have had coverage prior to pregnancy and fewer will have coverage after their postpartum checkup.  This is because Medicaid programs are federally required to provide coverage for “medically needy” people (pregnancy qualifies) but have more stringent requirements and a number of disqualifying factors for those who are not pregnant.  States which have expanded coverage may cover adults without children (allowing poor women to receive good care prior to conception and, thus, lowering risks of developing complications) and parents who have limited resources who are not medically needy.

For other women in states who have not expanded Medicaid, such as mine, the situation is even more grave.  In Missouri, to qualify as a pregnant woman for Medicaid, you can earn up to 196% of the federal poverty level (FPL).  Medicaid for parents only allows adults who make up to 18% of the FPL.  No matter what your income is, without a medically necessary reason (a serious disability, for example) you will not qualify for Medicaid In Missouri unless you have dependents.  Thus, the women most likely to benefit the most from preventative care before and after pregnancy that helps them monitor risk factors for heart disease may have a hard time qualifying for coverage.  These are women who will likely lose their ACA coverage under one of these plans or see the loss of important women’s health coverage under both plans.

Public policy which prioritizes women’s health would be a huge step forward in the battle against pre-eclampsia and, later, heart disease.  Thus, please call your legislators and inform them that we do not want to see coverage withdrawn but, instead, expanded.

To get more information about who you can contact, click here.