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Elizabeth Warren has a plan. Again.
The Massachusetts senator and 2020 presidential candidate unveiled a proposal Tuesday to curb maternal mortality among black and brown women. Black women are three to four times more likely than white women to die from pregnancy or childbirth-related ailments, and Warren wants to hold hospitals accountable for that gap.
Instead of letting hospitals charge for each procedure or service they offer — like an epidural — Warren wants to set a lump cost for each “episode” of care, like the entirety of a childbirth. The idea is to incentivize giving hospitals the flexibility to cover more services and to better evaluate their outcomes. And hospitals will then be held responsible for whether their patients get and stay healthy — and get bonuses if they do.
And Warren isn’t the only 2020 Democratic presidential candidate with a plan to tackle maternal mortality: California Sen. Kamala Harris, New Jersey Sen. Cory Booker, and New York Sen. Kirsten Gillibrand have introduced bills to fight bias within healthcare and expand insurance. This year, the U.S. black maternal mortality crisis has officially become an issue on the campaign trail.
“If care doesn’t improve, they’ll be on the hook.”
“This election is highlighting the power of a black woman voter,” said Vacheria Tutson, a fellow on the reproductive rights and health team at the National Women’s Law Center. “People are trying to figure out, ‘What are the issues that black women care about?’ And I think black women care about other black women dying.”
Warren first offered a snippet of her plan at last week's She the People presidential forum, the first to focus on the concerns of women of color — long one of the Democratic Party’s most reliable voting blocs. Black women, in particular, vote Democratic in overwhelming numbers: 94% voted for Hillary Clinton in the 2016 presidential elections, according to CNN exit polling.
Becoming a mother is more dangerous in the United States than in any other high-income country. American maternal mortality rates are more than three times higher than those in Canada or the United Kingdom, which also spend less on healthcare, NPR and ProPublica found last year. And for every woman who dies in childbirth, another 70 nearly perish. Many of the deaths and complications are preventable.
“This election is highlighting the power of a black woman voter.”
But black mothers face dramatically higher risks, a disparity that has endured for decades and cuts across class lines. In New York City, college-educated black mothers are more likely to have severe complications from pregnancy or childbirth than white women who didn’t graduate from high school, a 2016 report from the city health department found. Even tennis superstar Serena Williams couldn’t get doctors to listen when she suspected she had a pulmonary embolism. (She did, in fact, have blood clots.)
This crisis flows, in large part, from the American healthcare system’s long legacy of racism and gender discrimination, research has repeatedly demonstrated. Black women routinely struggle to access high-quality health care, partly thanks to a legacy of segregation, as NPR and ProPublica have noted. Providers also often demean their lives or dismiss their concerns. All this is compounded by the struggle to live in a racist and sexist society, a one-two punch of stress and structural obstacles that’s been linked to poor health for black women.
Harris’ bill would train healthcare providers to stop relying on stereotypes when treating patients and set up grants so states can offer comprehensive healthcare programs for pregnant women and new moms. New York Sen. Gillibrand has co-sponsored that legislation and both women have also co-sponsored New Jersey Sen. Booker’s bill to expand Medicaid access for new moms. In the Essence op-ed in which she outlined her plan, Warren said she supports those measures.
And in Warren’s plan, if healthcare systems start keeping more black moms alive, they’ll earn a bonus. “If care doesn’t improve, they’ll be on the hook. But they won’t be abandoned,” she wrote. Paying for better care means both rewarding excellent health systems and identifying, investing in, and demanding more from struggling ones.”
Warren acknowledged that her reforms “have limits.” More research would be needed to determine what, exactly, a “healthy” childbirth looks like. Different hospitals would require different levels of investment; patients won’t be helped if the federal government simply pulls money from struggling hospitals in impoverished communities to punish them for not improving their maternal mortality rates. And doulas, which have been linked to reduced cesarean and preterm births, aren’t usually provided by a hospital or covered by Medicaid.
Monica Simpson, executive director of the SisterSong Women of Color Reproductive Justice Collective, believes the plan outlined in Warren’s op-ed is “definitely a good step.”
“How do we create a world where black women are able to live without fear, to live without unnecessary stress?”
“We’ve heard all of the reports — and even the reports that we’ve done through our own organization — has shown the root cause of these issues is rooted in racism,” she said. “So making sure that there are ways to ensure that health care systems are held accountable is a very good plan.”
But Simpson doesn’t just want to throw money at a system whose entire approach to treating black women — and empowering non-white healthcare providers — needs to be overhauled. “We actually have to have more conversations, and to really dig deeper on what is wrong with health care systems.”
But cutting down on maternal mortality among black women isn’t just a matter of fixing the U.S. healthcare system. The consequences of living every day in a racist society, a process dubbed “weathering,” are so pervasive that they may cause even black women’s cells to age faster.
“It takes looking at all of the different social justice issues that we are dealing with in this country,” Simpson said. “How do we create a world where black women are able to live without fear, to live without unnecessary stress?”
Black Mamas Matter Alliance, a network that aims to improve maternal health for black women, says that the United States must prioritize building comprehensive, affordable health care in communities where black women live and work. They also want policies that address providers’ racism and gender discrimination — they endorsed Harris’ bill, with its anti-implicit bias trainings — and recognize the important role of figures like doulas, midwives, and lactation consultants.
“The first priority is to ensure that black women and black women-led organizations are included in the design and development of policy, programs, and solutions. And that they’re also prioritized for implementation,” said Elizabeth Dawes Gay, co-director of the Black Mamas Matter Alliance, who spoke with VICE News before the publication of Warren’s op-ed. “There are black folks that have been doing this work for a long time. They’ve been doing it under-resourced, potentially, and they have models of care, programs, and policy ideas that work.”
But while Tutson, of the National Women’s Law Center, liked much of the policy Warren that outlined — and that Warren stressed that reforms should be led by women of color — she said, “I don’t think she said anything that was like brand-new.”
Tutson was also skeptical about whether the Democratic Party is actually committed to solving the crisis; she wants to see a question about maternal mortality asked at a Democratic debate. “That’s when I’ll take presidential candidates seriously.”
Cover: Democratic presidential candidate U.S. Sen. Elizabeth Warren (D-MA) speaks at the National Forum on Wages and Working People on April 27, 2019 in Las Vegas, Nevada. (Photo by Ethan Miller/Getty Images)