Texas Senate OKs extending postpartum Medicaid — with an anti-abortion amendment

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Texas is on the precipice of giving new moms a full year of health care coverage, after the Senate unanimously passed a bill to extend Medicaid coverage. The bill has already passed the House, but due to a last-minute anti-abortion amendment, it will now return to that chamber to reconcile the different versions.

Supporters of the bill have called for the Legislature to pass a “clean bill,” without amendments, to ensure the federal government quickly approves Texas’ request to extend Medicaid coverage. A version of this bill that passed last session, extending coverage to six months, was deemed “not approvable” by the federal Centers for Medicare and Medicaid.

But on the Senate floor Sunday night, bill sponsor Sen. Lois Kolkhorst, R-Brenham, introduced an amendment and intimated the bill wasn’t going to pass the Senate without it.

“I’ve been on the phone all day,” Kolkhorst said. “My goal is to get this bill over the goal line and allay some of the … concerns of members on this floor…I think that this is a compromise that is best.”

At issue is boilerplate Medicaid language that says the year of coverage begins on the last day of pregnancy. It does not specify how that pregnancy has to end, which has led some anti-abortion groups and conservative lawmakers to claim it encourages abortion.

Kolkhorst introduced an intent amendment noting the purpose of the legislation is to “carry out the state’s profound respect for the lives of mothers and the unborn” by extending Medicaid to women who give birth or suffer “natural loss of the child. This does not include pregnancies that end through elective abortion.”

Sen. Nathan Johnson, D-Dallas, said including this language was unnecessary considering the near-total prohibition on abortion in Texas. Speaking to the members Kolkhorst said this amendment was intended to appease, Johnson noted that women who had illicit abortions were unlikely to try to seek Medicaid coverage after the fact.

“In the meantime, the entire program is vulnerable to not being approved by [the Centers for Medicare and Medicaid] precisely because of this language,” Johnson said. “I don’t want to gamble with women’s lives…so I wish you’d take these words out.”

“I respect that,” Kolkhorst said in response. “I’m really working through something that’s very complicated on this floor with a number of members … This is where we are tonight.”

Kolkhorst said her amendment served to quash other amendments that senators intended to try to attach to the bill, which would have “jeopardized” Texas’ application. Sen. Kelly Hancock, R-North Richland Hills, who Kolkhorst said she spoke with at great length on Sunday, pinned the issue on the federal government.

“It's my opinion that as Texans we're reaching out more than halfway to address the concerns of the federal government,” Hancock said. “If they fail us on this one, then they're failing the women in the state of Texas.”

The bill, with amendment attached, will now go to the House, which can either accept it or go to a conference committee to negotiate the difference. Gov. Greg Abbott has said he supports the legislation.

This bill has been years in the making, as the state’s own maternal mortality task force has called again and again for a full year of Medicaid coverage for new moms.

But now, in the wake of the overturn of Roe v. Wade, and with maternal deaths and injuries continuing to accelerate in Texas, a bipartisan coalition of lawmakers and advocacy groups have pushed the bill nearly to the finish line.

Texas is one of just 11 states that has not expanded Medicaid, leaving one in four women of childbearing age without health insurance. It’s easier to qualify for Medicaid during pregnancy, and fifty percent of births in Texas are paid for by the federal program.

But under current state law, those new moms lose their health insurance just two months after giving birth. At that point, many women are still dealing with birth complications and postpartum depression, and a full quarter of all maternal deaths in Texas in 2019 occurred after that period of coverage would have expired.

This bill comes at a crucial moment as the state is beginning to transition people off of Medicaid after access was temporarily expanded at the beginning of the COVID-19 pandemic three years ago.

Texas is reassessing the eligibility of nearly 6 million residents, including many who gave birth during the pandemic and have remained on Medicaid ever since. Anyone who is currently on Medicaid should make sure their information is up-to-date at YourTexasBenefits.com.

On Sunday night, Sen.José Menéndez, D-San Antonio, said while he wasn’t a fan of the amended language, he understood the need to get this bill passed through both chambers.

“If we truly have a commitment to life, first and foremost, is the mother's life and so that the mother can be healthy and take care of the children she has,” he said.

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