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Posts published in “Day: February 18, 2021”

Maternal mortality


The Idaho legislature spent no Idaho taxpayers’ money when it established a Maternal Mortality Review in 2019. The annual administrative cost was estimated to be $27K and “grant money” would fund it.

The legislature loves setting up panels and commissions and not having to pay for it. Still, this barely passed the House. All the representatives from my district supported it.

The guy who pushed for this spent some years on it, and he even approached me to sponsor it in 2016, my last year in the Senate. I warned him, a Democratic sponsor would be the kiss of death. Further, I just wasn’t sure the recommendations would be welcome, since at the time, the legislature wouldn’t even consider Medicaid Expansion. Maybe I was getting cynical.

Shame on me.

It’s not like I don’t support this sort of activity. For years, as county coroner we reviewed childhood deaths in my jurisdiction. Examining cases can teach us a lot. I found the childhood fatality reviews very helpful as I considered public policy. Former Governor Otter finally made these reviews a statewide policy in an executive order in 2012.

This panel has also made recommendations the legislature has ignored. Mainly, they suggested reviewing the “Religious Shield Laws” that prohibit prosecution of parents for neglect if a child dies from a treatable condition if the parents have religious beliefs blocking medical care. No such change has come before the legislature.

The MMR was directed to review deaths of women who were pregnant or had been pregnant within a year of their death and make recommendations for policy or procedural changes. The first report for 2018 is out. I don’t think their recommendations will be welcome.

Idaho has few maternal mortalities; there were only ten found for 2018. Still, the review panel thought almost all could have been prevented.
One of their recommendations was for maternal Medicaid coverage to be extended to 12 months after birth. It’s cut off at 6 weeks now.
Can you imagine our legislature doing that? Think of what it would cost!
Again, I apologize for the cynicism.

But the legislature’s attitude is no secret. When asked about spending on Medicaid in the budget committee, Representative Caroline Troy (R-Genesee) said: “I’ve never believed that Medicaid accomplishes what we want- which is the health of our citizens. So, for many of us this (funding) is a bitter pill to swallow.”

I think that is a prevalent attitude amongst our elected representatives. Remember, she even voted for the Maternal Mortality Review.
There is overwhelming evidence that good prenatal care saves money and saves lives. Idaho generously extended Medicaid coverage to pregnant poor women decades ago. There must have been some support for this back then.

Has it faded now?

I hope not.

But will the MMR recommendation to consider expanding coverage to 12 months after delivery even be considered? Apparently not from one of the representatives who voted to establish the review.

Don’t get me wrong, I understand this behavior. I see it every day. People make an appointment, come in a see me in the clinic, share a concern with me, then ignore my advice.

I’ve never carried a baby, it’s just not in my biology. I sure respect those who do. I did my share of prenatal care and deliveries. For many, this blessed event is a healthy and life growing experience. But, from my experience, not for all. I greatly appreciate the work this Maternal Mortality team has done, and I value their perspective and recommendations. I only wish our elected officials had the wisdom to at least consider, maybe act upon, the recommendations they wisely asked for.