AUSTIN, Texas – Texas has the highest rate of uninsured women of childbearing age in the nation, with one in four lacking coverage, according to a new report from the Georgetown University Center for Children and Families.

It says states that expanded Medicaid under the Affordable Care Act saw a 50% greater reduction in infant mortality than in non-expansion states.

Laura Guerra-Cardus, deputy director of Children's Defense Fund–Texas, explained that to ensure women have healthy pregnancies and babies, women need health-care coverage throughout their lives.

"States that have expanded Medicaid have seen reduced rates of both maternal deaths and infant mortality. They've reduced health disparities," said Guerra-Cardus. "African-American women are three times as likely to die from childbirth and pregnancy complications."

Texas lawmakers have argued that expanding Medicaid could leave the state on the hook if the Affordable Care Act implodes.

But Guerra-Cardus noted lawmakers are leaving $6 billion a year on the table that could provide health coverage for more than 1 million Texans. She believes the largely partisan opposition to expansion should be put aside to prioritize the lives of women and children.

Joan Alker, executive director of the Georgetown University Center on Children and Families, pointed out that among developed nations, maternal mortality in the United States is going in the wrong direction.

She is convinced that Medicaid expansion is the single most important step states can take to address the crisis, in part because steady, uninterrupted health coverage is critical for healthy birth outcomes.

"Some pretty big states – like Texas, Florida, Georgia – have coverage gaps," Alker said. "And as a result, we see those states that have not expanded Medicaid under the Affordable Care Act, the uninsurance rate for women of childbearing age is nearly twice as high as those states that have expanded Medicaid."

In non-expansion states, many women only get coverage after they find out they're pregnant, which Alker calls problematic when a growing body of research shows that women need to be healthy at the time of conception.

States that expanded Medicaid improved maternal health outcomes by increasing access to preventive care, and also reduced adverse health outcomes before, during and after pregnancies.

The Georgetown report was released in conjunction with the March of Dimes and the American College of Obstetricians and Gynecologists.

New York legislation could help working families in the state cope with rising prices.

The Working Families Tax Credit would combine a patchwork of tax credits, the current Empire State Child Credit, the Earned Income Tax Credit and several others. The bill would also raise the maximum tax credit to $1,600 with a $100r minimum credit per child, regardless of family income.

Sen. Andrew Gounardes, D-Sunset Park, the bill's sponsor, said financing the credit will not cost much in the state's budget.

"There are a number of loopholes that exist in the state tax code we can look to close to pay for this," Gounardes pointed out. "But there's no reason why New York should continue to have three of the 'top 10 worst states for child poverty,' given the vast amounts of money we spend in our state every single year clearly are not achieving the results we need it to achieve."

He noted feedback on the bill has been positive from lawmakers and New Yorkers but it is the third time this proposal has been introduced. Gounardes explained competing budget priorities are the primary challenge to getting it passed and stressed he is confident.

The attempt to pass the measure comes as Gov. Kathy Hochul announced plans to expand the state's Child Tax Credit. Hers would raise the credit to $1,000 annually per child under age 4 and $500-dollars for children ages 4-16.

Gounardes supports Hochul's plan and said a Working Families Tax Credit would put even more money in families' pockets.

"Kids, even though it might be more expensive when they're younger, they don't stop needing things," Gounardes pointed out. "They don't stop needing school clothes, school supplies; they don't stop eating, they don't stop needing heat and a roof over their head. So, I think the governor's proposal is a great start to a conversation about what will it take to support families who are struggling the most."

A 2023 University of Washington report found almost two of five households in New York cannot afford basic needs and more than 2 million New York households struggle to get by solely on their earnings.


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With state lawmakers back in Boise, changes could be coming to Medicaid.

Voters approved Medicaid expansion in 2018, but Republican legislators have consistently said the program is too costly for Idaho. Some are considering repealing the expanded program. However, such radical changes could hurt families the most.

Randi LaSalle, a single mom with four kids on Medicaid, said at one point, she was working two jobs and paying $800 per month for private health insurance, which was more than her rent.

"I stopped working two jobs because it just wasn't feasible with trying to take care of a bunch of kids and bouncing between counties to kind of keep up two jobs," LaSalle explained. "Things are a little tighter, but at least now I don't have to pay for insurance anymore."

Expansion helped cover people who made too much to qualify for Medicaid and fell into a coverage gap. The program covers about one in six adults and three in eight children in Idaho. LaSalle hopes legislators make the program more accessible for families this session.

Randy Johnson, Idaho government relations director for the American Cancer Society Cancer Action Network, said health coverage is important for preventive care and cancer treatment, and repealing or placing barriers to Medicaid access won't stop people from getting sick.

"People still are going to go to the hospital, and taxpayers are still going to end up covering those costs," Johnson pointed out. "It's just not up-front, and instead of going to their doctor, they're going to have to go to the ER, which is way more expensive."

Johnson argued changes would mean fewer people are covered in Idaho, which would hurt families.

"It creates that coverage for people who are working, who are doing the right thing, who want to make sure that their families are protected," Johnson stressed. "This helps them do that."

Supporters of the health program are holding Idaho Supports Medicaid Day at the Capitol on Jan. 28 in Boise.


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Advocates for working families in New York say they want less talk and more action to improve child care in the state.

Gov. Kathy Hochul has proposed a child-care construction fund and a task force to address the issue - which advocates say will make a dent in the child-care shortage, but doesn't do enough.

Estimates show New Yorkers spend a grand total of $14 billion a year on child care, or about $22,000 per year, per child. High child-care costs also are cited as a major reason young families leave the state.

Rebecca Bailin, executive director of New Yorkers United for Childcare, said universal child care is possible if the state will fund plans to implement it.

"That child care would be free, easy to apply, nearby and accessible to all families," she said. "There's no reason, with a budget of $237 billion, she cannot start to implement universal public child care now."

Bailin said a lack of political will has been the biggest hurdle for universal public child care, since 74% of New Yorkers say they want it. Feedback from some state lawmakers is positive, although enacting a universal plan could cost $12 billion a year - 6% of the state's current budget.

A Cornell University poll found high child-care costs are one reason some people can't join the workforce, while other reasons are lack of accessible child care that keeps people from working.

Bailin said a universal public system could counteract these economic harms.

"It's a $10 to $13 return on investment for every dollar spent," she said. "Making New York an affordable place for families will help to stop the exodus of families, make it possible for us to grow our workforce and our tax base."

Although New York offers child-care programs, some families earn too much to qualify for them, or have issues with immigration status that keep parents from reaching out. Bailin said expanding New York's Child Tax Credit and Working Families Tax Credit could help the system, as well as investing in the child-care workforce.


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