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      ‘It’s easy to dismiss Black women’s lives’: Texas drags feet on maternal mortality crisis

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      When medical staff prepped Shawn Thierry for an emergency C-section, she knew something was very wrong. After an epidural, excruciating pain ran through her legs. Soon, she could barely breathe.“I felt like my heart was going to jump out of my chest and that I might die,” she said.She screamed for her doctor to put her under anesthesia – which happened to be the solution. The epidural, Thierry later found out, was given too high in her spine, causing a paralysis that inched toward her heart.“I was an attorney who had full private healthcare coverage and I almost died,” said Thierry, of the birth of her daughter in 2012. “I cannot imagine what the outcome would be for the thousands of other African American women without health insurance.”Years later, as a member of the Texas House, Thierry was “stunned” to learn of the state’s maternal mortality crisis.The US has the highest maternal death rate among similarly developed countries and is the only industrialized nation where such deaths are rising. But according to data from the federal Centers for Disease Control and Prevention, in Texas the maternal mortality rate is above the US average, at 18.5 deaths per 100,000 live births.Black women in the state are “disproportionately” affected, accounting for 11% of live births but 31% of maternal deaths. Wide racial and ethnic disparities exist nationally too.I was shocked that black mothers like myself are three times more likely to die than our white counterparts“I was shocked that black mothers like myself are three times more likely to die than our white counterparts,” said Thierry. “And no one in the legislature was really talking about it.”She has repeatedly filed legislation to combat the glaring problem. Her proposals included racial bias training for medical professionals and a bill to fix a “severe” maternal health data backlog by creating a centralized registry.They did not advance in 2019, or in the current legislative session which ends this weekend. Focused on restricting abortion rights, the male- and Republican-dominated state legislature has dragged its feet on maternal mortality.Health advocates were cautiously optimistic that in 2021 Texas lawmakers would at least usher through a proposal to extend Medicaid care to a year after birth.Lawmakers did take action. A proposal was sent to Governor Greg Abbott on Friday. But it stopped short of providing the full Medicaid expansion.‘A large racial disparity’A state maternal mortality and morbidity review committee found that out of pregnancy related deaths in Texas in 2013, about a third occurred 43 days to a year after the end of pregnancy. It also discovered that nearly 90% of such deaths were preventable. Among the leading underlying causes of death with the highest chance of preventability were infection, hemorrhage, preeclampsia and cardiovascular conditions.“It was really striking,” said Dr Amy Raines-Milenkov, a University of North Texas Health Science Center professor and member of the review committee. “We found that most of these deaths could have been prevented but the system is just not set up to prevent them. And we found a large racial disparity, which is a reflection of how we in society value women, especially African American women.”Since 2016, the committee’s No1 recommendation to help save lives has been to extend Medicaid coverage postpartum for low-income mothers to a year. Currently, Texas kicks new moms off Medicaid after 60 days, leading to delayed and less preventative care. The American Medical Association and the American College of Obstetricians and Gynecologists support longer postpartum care.“So many health problems can develop in this really sensitive time period, so it is critical that new moms have that full year of extended coverage,” said Raines-Milenkov. “To think new mothers can identify problems, get timely appointments and follow up with their doctors within just two months of having a baby is unrealistic. Anything less than 12 months is really insufficient.”The Biden administration recently initiated incentives for states to expand postpartum coverage to 12 months. Illinois was the first to have its extension approved and other states including Florida and Virginia hope to implement measures soon.Toni Rose, a Dallas representative, joined Thierry in filing HB 133, to do just that in Texas. The Republican-dominated House passed the bill with rare bipartisan approval and nearly 70 groups, from the Texas Medical Association to the rightwing Texas Public Policy Foundation, expressed support.When it comes to saving the lives of Texas mothers, ‘splitting the difference’ is not appropriateHowever, the ultra-conservative Texas Senate – which ushered through extremist anti-abortion bills in March – did not pass the bill until the final minutes of its session. Even then, the legislation was not what was proposed. Without explanation, Republican Lois Kolkhorst of Brenham reduced the year of coverage to six months.Rose called the legislation a “victory” but said it still “falls short”. Thierry expressed dismay.“The data is clear that women are still at risk of maternal mortalities and pregnancy related complications for up to one year postpartum,” she said. “While the six months negotiated by the Texas Senate is better than the status quo, many new mothers will still be deprived of quality healthcare at a time when they are most vulnerable.“Given that this is an issue in which I have both personal and professional experience, I am disappointed. When it comes to saving the lives of Texas mothers, ‘splitting the difference’ is not appropriate.”Marsha Jones, executive director of the Afiya Center, a Dallas group that supports Black women with reproductive healthcare, said the lack of substantial progress was partly a reflection of the legislature’s misplaced priorities and lack of diversity.The Texas legislature is comprised mostly of white males: 61% of lawmakers in the House and Senate are white, even though white Texans make up just 41% of the population. Women are vastly outnumbered by men.“Black women are dying at an alarming rate for reasons that could be prevented and our state leaders cut down the main proposal that a state-appointed committee recommended to help them – why would that even happen?” said Jones. “I think it’s because it’s so easy to dismiss Black women’s lives.”The legislature expended time and energy on restricting abortion access, including passing one of the most extreme bans in the country, which allows any citizen to sue an abortion provider, as well as a “trigger” bill that bans the procedure in the event Roe v Wade, the 1973 ruling which safeguards the right to abortion, is overturned by the US supreme court.Both measures were “top legislative priorities” for the Senate leader, Lt Gov Dan Patrick, who did not make maternal mortality a listed priority.“It seems the only time we want to stand up and care about a life is when it’s in the womb,” Rose told Republicans on the House floor in May.‘Women are obviously choosing a life’In an ideological quest to punish abortion affiliates, Republicans have decimated the Texas reproductive health safety net by blocking low-income Medicaid patients from receiving life-saving preventative care at Planned Parenthood, a move resulting in reduced access to contraception and increased rates of Medicaid births, according to the Texas Policy Evaluation Project.A recent study in the medical journal Contraception showed a correlation between high maternal mortality rates and states that pass abortion barriers.“We have a maternal health crisis and conservative legislators once again made anti-choice bills a priority,” said Thierry. “They fail to realize all the women threatened by maternal deaths are obviously choosing life – they shouldn’t have to do so in exchange for their own.”Lawmakers made no significant gains for Medicaid in general. Texas is home to the highest number of uninsured residents in the US as well as the highest percentage of uninsured women of childbearing age, but it has declined to expand Medicaid under the Affordable Care Act and Republicans blocked legislative efforts to help extend healthcare coverage for the working poor.Texas has one of the steepest Medicaid eligibility requirements in the US. Of 1.4 million Texans who would benefit from expanded Medicaid, 75% are people of color.“Once again, we are kicking the can down the road with many of these solutions,” said Thierry. “It’s absolutely imperative we continue to work on reducing maternal mortality. One death is too many, especially when it’s preventable.” More

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      The first 100 days of Biden were also the first 100 without Trump – that’s telling | Robert Reich

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      By almost any measure, Joe Biden’s first 100 days have been hugely successful. Getting millions of Americans inoculated against Covid-19 and beginning to revive the economy are central to that success.Two-thirds of Americans support Biden’s $1.9tn stimulus plan, already enacted. His infrastructure and family plans, which he outlined on Wednesday night at a joint session of Congress, also have broad backing. The $6tn price tag for all this would make it the largest expansion of the federal government since Lyndon Johnson’s Great Society. But for most Americans, it doesn’t feel radical.Rather than bet it all on a single large-scale program such as universal healthcare – which Bill Clinton failed to accomplish and which Barack Obama turned into a target of Republican fearmongering – Biden has picked an array of popular initiatives, such as preschool, public community college, paid family and medical leave, home care and infrastructure repairs, which are harder to vilify.Economists talk about pent-up demand for private consumer goods, caused by the pandemic. Biden is responding to a pent-up demand for public goods. The demand has been there for years but the pandemic has starkly revealed it. Compared with workers in other developed nations, Americans enjoy few if any social benefits and safety nets. Biden is saying, in effect, it’s time we caught up.Even on the fraught issue of race, the contrast with Trump has strengthened Biden’s handBesides, it’s hard for Republicans to paint Biden as a radical. He doesn’t feel scary. He’s old, grandfatherly. He speaks haltingly. He’s humble. When he talks about the needs of average working people, it’s clear he knows them.Biden has also been helped by the contrast to his immediate predecessor – the most divisive and authoritarian personality to occupy the Oval Office in modern memory. Had Biden been elected directly after Obama, regardless of the pandemic and economic crisis, it’s unlikely he and his ambitious plans would seem so benign.In his address to Congress, Biden credited others for the achievements of his first 100 days. They had been accomplished “because of you”, he said, even giving a nod to Republicans. His predecessor was incapable of crediting anyone else for anything.Meanwhile, the Republican party, still captive to its Trumpian base, has no message or policies to counter Biden’s proposals. Donald Trump left it with little more than a list of grievances irrelevant to the practical needs of most Americans: that Trump would have been re-elected but for fraudulent votes and a “deep state” conspiracy, that Democrats are “socialists” and that the “left” is intent on taking away American freedoms.Biden has a razor-thin majority in Congress and must keep every Democratic senator in line if he is to get his plans enacted. But the vacuum on the right has allowed him to dominate the public conversation about his initiatives, which makes passage more likely.Trump is aiding Biden in other ways. Trump’s yawning budget deficits help normalize Biden’s. When Trump sent $1,200 stimulus checks to most Americans last year regardless of whether they had a job, he cleared the way for Biden to deliver generous jobless benefits.Trump’s giant $1.9tn tax cut for big corporations and the wealthy, none of which “trickled down”, make Biden’s proposals to increase taxes on corporations and the wealthy to pay for infrastructure and education seem even more reasonable.Trump’s fierce economic nationalism has made Biden’s “buy American” initiative appear innocent by comparison. Trump’s angry populism has allowed Biden to criticize Wall Street and support unions without causing a ripple.At the same time, Trumpian lawmakers’ refusal to concede the election and their efforts to suppress votes have alienated much of corporate America, pushing executives toward Biden by default.Even on the fraught issue of race, the contrast with Trump has strengthened Biden’s hand. Most Americans were so repulsed by Trump’s overt racism and overtures to white supremacists, especially after the police murder of George Floyd, that Biden’s initiatives to end police brutality and “root out systemic racism”, as he said on Wednesday night, seem appropriate correctives.The first 100 days of the Biden presidency were also the first 100 days of America without Trump, and the two cannot be separated.With any luck, Biden’s plans might prove to be the antidote to Trumpism – creating enough decent-paying working-class jobs, along with benefits such as childcare and free community college, as to forestall some of the rightwing dyspepsia that Trump whipped into a fury. More

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      Arkansas and South Dakota pass bans targeting transgender minors

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      Arkansas lawmakers have approved a ban on gender-affirming healthcare for transgender children, sending the governor a bill that has been widely criticized by medical and child welfare groups.The Senate voted 28-7 on Monday in favor of the legislation. If the bill is enacted it would be the first prohibition of its kind in the country, opponents say. The bill would prohibit doctors from providing gender confirming hormone treatment or surgery to minors, or from referring them to other providers for the treatment. It also allows private insurers to refuse to cover gender-affirming care for trans people of any age.The legislation restricts treatments that have been endorsed by major medical associations and human rights groups. They say the care is well established and part of a gradual process that has been shown to dramatically improve the mental health of the most vulnerable kids.The state’s governor Asa Hutchinson a Republican, has not said whether he supports the measure, but has previously supported anti-trans bills. He has five days, not counting Sunday, after the bill reaches his desk to sign or veto the legislation before it becomes law without his signature.The measure is among dozens of bills targeting trans people that have advanced in Arkansas and other states this year. Arkansas, Mississippi and Tennessee have enacted measures prohibiting trans girls and women from competing in school sports teams consistent with their gender identity. On Monday, South Dakota’s governor also issued an executive order to prohibit trans girls from playing on girls’ sports teams.Conservative legislators have introduced more than 80 bills restricting trans rights in the US so far this year – most that would either block trans kids’ use of gender-affirming care or limit their access to certain sports teams. It is the highest number of anti-trans legislative proposals ever filed in a single year.Hutchinson on Friday signed a law that would allow doctors to refuse to treat someone because of religious or moral objections, a move that opponents say could be used to turn away LGBTQ+ patients.Opponents of the measure include the American Academy of Pediatrics. The American Civil Liberties Union said it plans legal action to block the treatments ban if it’s signed into law.If signed, the ban would take effect later this summer. More

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      Why Medicare for All is a political headache: Politics Weekly Extra – podcast

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      The Guardian health reporter Jessica Glenza steps in for Jonathan Freedland this week. She speaks to Dr Abdul El-Sayed, co-author of a new book, Medicare for All: A Citizen’s Guide, about why the concept of providing healthcare coverage for all Americans is so politically vexing

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      No three words are likely to elicit a more divisive response in Washington than “Medicare for all”. From the outside looking in, some might wonder why any politician – Republican or Democrat – would hesitate to provide universal health coverage to all Americans. The answer goes to the core of American ideas about the role of government and the free market. This week Jessica Glenza speaks to Dr Abdul El-Sayed, a physician and epidemiologist and co-author of a new book, Medicare for All: A Citizen’s Guide. He also ran for governor of Michigan, where he advocated for universal healthcare. Send us your questions and feedback to podcasts@theguardian.com Help support the Guardian by going to gu.com/supportpodcasts More

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      The Ten Year War review: Obamacare, Trump and Biden's battles yet to come

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      Once upon a time, the Affordable Care Act (ACA) was unpopular, viewed by many as welfare redux. Barack Obama’s promise that “If you like your healthcare plan, you’ll be able to keep your healthcare plan”, didn’t exactly work out. By the middle of the 2010s, so-called Obamacare had cost the Democrats both houses of Congress.
      Yet one great recession and one raging pandemic later, the ACA is liked, if not necessarily loved, by a majority of Americans.
      The political process “doesn’t stop just because a bill becomes a law”, according to Jonathan Cohn.
      As if to prove Cohn’s point, the US awaits a ruling by the supreme court on another challenge to Obamacare, this one brought by the Trump administration and Republican state attorneys general. If they prevail, more than 20 million Americans may lose health coverage. Nearly a half-million have died from Covid. Markets don’t always deliver what is needed.
      The Ten Year War is a look back at the “crusade” for universal healthcare coverage, and a sequel to Cohen’s earlier book, Sick: The Untold Story of America’s Healthcare Crisis. Cohn is a senior correspondent at the Huffington Post. His take remains informed and nuanced, not breathless. The Ten Year War also captures acrid and tectonic shifts in US politics.
      Cohn persuasively argues that the combatants in the healthcare fight operated with less than perfect knowledge, and that preconceived convictions too often clouded their judgment. Cohn aims at both policy wonks and political junkies. Laced with interviews and quotes from both sides of the aisle, his book is definitely newsworthy.
      Obama and Tom Price, Donald Trump’s short-tenured health secretary, speak on the record. David Axelrod, Obama’s counselor, and Michael Carvin, a veteran conservative litigator who unsuccessfully argued against Obamacare’s constitutionality, also talk to the author. Years earlier, in the 2000 election, Carvin was on brief in George W Bush’s winning supreme court gambit.
      Obama admits his surprise over Republicans not moving on after the ACA passed, unlike Medicare in 1965 under Lyndon Johnson. “We got no take-up on any of that stuff,” he says. Left unsaid is that blue and red are more than just colors – they are tribes.
      By the same measure, Obama acknowledges “that there were those … who suggested that we shouldn’t do anything other than the economy”. That is an understatement.
      One of those “outsiders” was Chuck Schumer, now the Senate majority leader. Even then, Cohn writes, the New Yorker grasped the political consequences of going all-in on healthcare amid a meltdown in the jobs and housing markets.
      Indeed, after the Democrats lost the Senate in 2014, New York’s senior senator unloaded on Obama before the National Press Club: “After passing the stimulus, Democrats should have continued to propose middle-class-oriented programs.” Said differently, the ACA highlighted the inherent instability of the Democrats’ upstairs-downstairs coalition.
      Instead, in Schumer’s telling, “we took their mandate and put all of our focus on the wrong problem – healthcare reform.” Apparently, there are few things more gratifying in politics than telling a sitting president: “I told you so.”
      Of course, political myopia is not the sole province of any one party. Price admits that Republicans too operated in their own universe.
      “I think there was a lack of appreciation on the part of all of us in the administration about how difficult” repealing Obamacare would be, he says. Price is a physician as well as a former Georgia congressman.
      Price criticizes Trump for fashioning policy to comport with the last voice to whisper into his ear, and for a fundamental lack of understanding of healthcare and insurance.
      “We would make concrete decisions about what we were going to do,” he says, “get presidential sign-off, and then within 24 hours the decision would change.”
      For Price’s boss, pulling the rug out from under others was standard operating procedure. More

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      Biden's pandemic problem: Politics Weekly Extra podcast

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      Jonathan Freedland speaks to the Pulitzer prize-winning author and journalist Laurie Garrett about what Joe Biden needs to do to get a grip on the Covid crisis in the US

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      When Joe Biden entered the Oval Office as president, he got to work trying to figure out how to mitigate the coronavirus situation in the US, and what exactly he was up against. Jonathan speaks to the expert on how governments plan for pandemics, Pulitzer prize-winning author and journalist Laurie Garrett about how she knew a crisis like this was coming but why no one in government chose to act. They also discuss what the Biden administration needs to do next. Send us your questions and feedback to podcasts@theguardian.com Help support the Guardian by going to gu.com/supportpodcasts More

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      in Elections

      Biden announces 'wartime' boost in vaccine supply – video

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      The Biden administration is increasing vaccination efforts with a goal of protecting 300 million Americans by early fall, as the administration surges deliveries to states for the next three weeks following complaints of shortages and inconsistent supplies. ‘This is enough vaccine to vaccinate 300 million Americans by end of summer, early fall,’ Biden said. ‘This is a wartime effort,’ he added, saying more Americans had already died from the coronavirus than during all of the second world war
      Biden vows to vaccinate 300m in the US by end of summer or early fall – live
      Joe Biden appears to boost vaccination goal to 1.5m Americans per day More

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      'A liberating feeling': Fauci critiques Trump administration – video

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      Dr Anthony Fauci made not-so-veiled critiques of the Trump administration during a White House press briefing on Thursday. He said the new administration meant he did not need to ‘guess’ when he didn’t know the answer to questions.
      The health expert said the new administration felt ‘liberating’ and he did not take pleasure correcting the president and facing consequences for doing so.
      But Fauci pushed back against the characterization from some Biden officials that the new administration has to start ‘from scratch’ on coronavirus vaccine distribution
      US politics: latest updates More