Maternal Health Care in Wisconsin and the Future of Medicaid

Zac Schultz:
Wisconsin faces a maternal health care crossroads. While the state Senate just passed a bill to extend postpartum Medicaid coverage from 60 days to a full year, the Assembly’s history of stalling the measure leaves thousands of new mothers in limbo. “Here & Now” reporter Aditi Debnath has the story.

Wendy Yuen:
With my daughter, I had really bad postpartum depression and it was a struggle.

Aditi Debnath:
Wendy Yuen is not alone. In Wisconsin, two out of every five mothers give birth on Medicaid. That’s the program that provides health coverage to low-income people. Most states expanded Medicaid to cover postpartum mothers for a year. In Wisconsin, mothers lose coverage just two months after delivery. For many, that means no support during a time of immense physical and emotional change.

Wendy Yuen:
I was on leave when I realized that it was really bad. So at that time, I was only making 60% of my pay and I could barely afford to pay my mortgage and just be able to take care of my son and the new baby and myself.

Ryan Spencer:
Any expansion to Medicaid is highly likely, in any given area or state, to improve access that women have to prenatal care, intrapartum care, and postpartum care.

Aditi Debnath:
Dr. Ryan Spencer is an ob-gyn at the UW-Madison Medical School. He says the state is in a maternal health care crisis, in part due to years without Medicaid expansion.

Ryan Spencer:
I think we’re actually in the long-term impacts of having not addressed those for decades.

Aditi Debnath:
The state Senate’s recent vote to extend postpartum Medicaid coverage to a year aims to address the need for care. The bill passed with support from nearly every lawmaker, signaling rare bipartisan agreement on the issue.

Chris Larson:
I think everyone else gets it. Anyone who’s had kids or anybody who’s been around kids knows that the more that you can have that person-to-person attention and frankly, take things off the plate of that parent, the better.

Aditi Debnath:
But the Senate’s vote contrasts sharply with Assembly Speaker Robin Vos’ repeated blocks. He said ahead of the Senate vote…

Robin Vos:
My position has been fairly clear from the very beginning. I’ve never supported an expansion of welfare. I can’t imagine that I would ever support one, but we have to talk about it as a caucus and see where everybody else is.

Aditi Debnath:
Representative Pat Snyder, who introduced the postpartum coverage bill in the Assembly, stresses that this is not a partisan issue.

Pat Snyder:
I’ve told some of the opponents saying that if a mom dies, a lot of times, that might mean the child has to go into foster care or, you know, things to that nature. That’s going to cost the state more than if we just help the moms if they need the help. So, you know, you got to sometimes talk to them about dollars and cents.

Aditi Debnath:
Wisconsin is now one of two states in the nation without a full year of postpartum Medicaid coverage.

Wendy Yuen:
The short period of time that’s covered under state insurance isn’t really enough. Like my daughter’s one and I’m still struggling every day just to, like, keep up with all the things that I have to do to make sure that she’s healthy.

Aditi Debnath:
The challenge is even greater for mothers living outside Wisconsin’s larger cities. Only about half of rural hospitals in the state offer labor and delivery services. Many of those mothers are on Medicaid, which reimburses hospitals significantly less for services.

Ryan Spencer:
Increasing the reimbursement for obstetric care would undoubtedly increase opportunities for hospital systems to run effectively.

Aditi Debnath:
Availability of obstetric services in rural areas has gone down for more than a decade. According to the U.S. Government Accountability Office it is difficult for hospitals in rural areas to recruit and retain maternal health providers. Also, a higher proportion of rural patients rely on Medicaid, which doesn’t fully cover obstetric services. The recent end of birthing services at a rural hospital in northern Wisconsin makes accessing care more difficult. When ThedaCare announced it would close its Waupaca birthing unit, the Common Council unanimously passed a resolution asking it to reconsider. For its part, ThedaCare said “The needs and demands of expectant mothers are shifting. Deliveries have been declining and mothers are choosing to deliver at larger birth centers. The shortage of physicians and nurses in rural areas is an issue being felt across the country and in our region, as labor and delivery complexity is increasing.”

Ryan Spencer:
What you see when you lose a birthing center for a community, increased number of births outside of hospitals. You see an increased number of preterm births when you lose a birthing center as well. You lose the opportunity to get easy access to prenatal care and postpartum care because you don’t have those particular clinicians in that area anymore.

Aditi Debnath:
The nearest full-service hospital is now 30 miles away in Stevens Point. That distance can make a difference in a labor and delivery emergency. The ThedaCare hospital in Waupaca still provides postpartum and prenatal care.

Tony Evers:
Let’s extend postpartum coverage for pregnant women on BadgerCare up to one year after giving birth.

Aditi Debnath:
Governor Evers has once again included the postpartum Medicaid extension in his 2025-2027 budget proposal, alongside more than $18 million over the next two years to increase Medicaid reimbursement rates for obstetric services.

Tony Evers:
There’s also a bipartisan bill to get it done that almost 90 legislators support.

Aditi Debnath:
With the budget debate heating up, Dr. Spencer warns that without action, more birthing units will close and more mothers will fall through the cracks.

Ryan Spencer:
We know that there is something going on related to the health, wellbeing and mortality of women giving birth in rural areas that for some reason is not experienced in urban areas. The CDC has told us your zip code matters as to how risky pregnancy is for you, and we need to pay attention to that.

Aditi Debnath:
Reporting from Madison, I’m Aditi Debnath for “Here & Now.”