As maternal death rates go up, states are considering whether to extend postpartum coverage through Medicaid. Supporters in Iowa hope lawmakers take advantage of federal incentives and join the list.

Under the American Rescue Plan, states have the option to seek matching funds allowing 12 months of postpartum Medicaid coverage. The current requirement is 60 days.

Dr. Lena Rydberg Freese, internal medicine specialist at the Iowa Clinic and an American Heart Association board member, said she often sees new mothers after they have given birth. She feels yearlong coverage would address common lingering health effects tied to a pregnancy.

"That's going to do a lot better job of getting hypertension levels back to normal and getting their risk factors under a little bit better control," Rydberg Freese recommended. "So that they are better able to prevent the long-term health consequences of not treating this."

The American Heart Association said other risk factors for new mothers include blood clots and stroke.

Currently, four out of every 10 births in Iowa are covered by Medicaid. Nationally, cost barriers result in an unmet medical need for one in five uninsured new moms. There is a proposed extension in the Iowa Senate, but an added provision dealing with pregnancy counseling and avoiding abortions has seen pushback.

Meanwhile, the Centers for Disease Control and Prevention noted the maternal death rate in the United States has steadily increased, going from 17 per 100,000 births in 2018 to 23 in 2020. The rates are much higher for Black women.

Rydberg Freese pointed out those disparities exist in Iowa.

"It has not been, I think, as well recognized as a problem in the Midwest as it has in some of our coastal regions," Rydberg Freese observed. "But we see that magnitude is, is a little bit greater."

The federal incentives for the extended coverage, which begin Friday, sunset after five years. Nearly 30 states have either adopted extensions or are considering it.

Rydberg Freese added if Iowa were to move ahead, it would help families feel like they are supported here.

"I want my young moms to be in good health, because that helps them do all the things that they need to do for their families, for their communities," Rydberg Freese asserted.

The Heart Association is encouraging those who want a coverage extension to speak up through the group's You're the Cure platform.

Abortion is set to be prohibited in Idaho at the end of July after the U.S. Supreme Court's decision to overturn Roe v. Wade last week.

The justices ruled that the 50-year precedent of Roe should be overruled, setting off so-called "trigger laws" in 13 states, including Idaho.

Kim Clark is senior attorney for reproductive rights, health, and justice with the Pacific Northwest organization Legal Voice. She said there will be some out-of-state options for Idahoans seeking access to abortions.

"Abortion funds across the country, including the Northwest Abortion Access Fund here in Washington," said Clark, "are ready to provide support to people who need to travel across state lines to access care, and I think there will be other informal networks of support."

Conservatives have celebrated the decision. In a statement, Idaho Gov. Brad Little said the right to an abortion was a "judicial creation."

Idaho's ban makes providing abortions a felony. There are exemptions for cases of incest and rape, although victims will have to provide a police report to a physician, which can take several weeks to obtain.

States where abortion will remain legal, including Washington and Oregon, are expected to see large increases from the number of people seeking care there. Clark said providers in those states will be burdened with the increase in traffic.

"The other place where folks can help out," said Clark, "is in supporting providers in safe haven states who will be stepping up to absorb a great deal of uncompensated care as folks come into those states for access to care."

Idaho legislators passed another law this session similar to a ban in Texas that allows civil lawsuits against health professionals who provide abortion. That law has been blocked but the Idaho Supreme Court is scheduled to hear oral arguments on the case on August 3.

Clark said while these laws make getting an abortion much harder, they won't go away completely in Idaho

"The reality is that no action that the Idaho Legislature takes will ban abortion in Idaho," said Clark. "People will still access care."

The South Dakota state Legislature is expected to convene in a special session to reassess abortion laws. Gov. Kristi Noem vowed to call the special session in the wake of the decision by the U.S. Supreme Court to overturn Roe v. Wade.

The ruling triggered South Dakota's ban, so abortion is now illegal except to save the woman's life.

Shannon Olivieri Hovis, California director for NARAL Pro-choice America, slammed the ruling.

"We are talking about more than 33 million women who will lose that access to abortion in their own communities in their home states," Olivieri Hovis asserted. "And some may be at risk of criminalization for accessing self-managed abortion in their states. And some will die."

Noem, who is running for reelection, has said she does not support an exception for cases of rape or incest, but instead is promoting a new website called life.SD.gov, which promises to provide "resources for pregnancy, new parents, financial assistance and adoption."

In 2006 and 2008, South Dakota voters rejected ballot measures to ban abortion in the state. Olivieri Hovis thinks the state Legislature is out of touch with public opinion.

"Eight in 10 Americans support the legal right to abortion," Olivieri Hovis pointed out. "That does not mean every one of those eight people would choose abortion for themselves, but they do not believe that anyone else should be making that decision."

The Legislature is expected to consider proposals to tighten abortion restrictions. For now, it remains legal to travel to other states such as Minnesota for abortion care and websites like abortionfinder.org and abortionfunds.org have sprung up to facilitate it.

Pro-choice advocates are calling on voters to make access to abortion a big issue in the November midterm election. The countdown has begun; in less than a month, North Dakota's trigger law will make abortion illegal except to save the pregnant person's life, since the U.S. Supreme Court has overturned Roe v. Wade.

Amy Jacobson, executive director of Prairie Action ND, said a lot of North Dakotans want access to abortion care.

"North Dakota voters rejected an abortion ban in 2014 by a two-to-one margin. Those are Republican voters defeating an abortion ban in our state," Jacobson pointed out. "I would just really call on them to reflect on where their party is going and what this means for the people of our state. "

The state Legislature, citing religious and moral objections, tried to add an abortion ban to the state constitution, but the accompanying ballot measure failed in 2014.

In mid-May, pro-choice protesters held "Ban Off Our Bodies" rallies in Bismarck, Fargo, Grand Forks and Minot. More are planned for early July. The state's only abortion provider, the Red River Women's Clinic in Fargo, announced plans to move across the border to Moorhead, Minnesota in the near future.

Jacobson laments what she calls an ultraconservative takeover of the Republican Party.

"This decision really comes from the right-wing majority of extremist judges that have undermined the fundamental right to make our own decisions about our health care, our bodies, and our families," Jacobson asserted.

North Dakota already has a ban on abortion consultations via telehealth. Jacobson predicts when the next legislative session begins in January, lawmakers will introduce bills to further restrict abortion, by making it illegal to travel to another state for an abortion or to help someone else do so.