Comments Prepared for Congressional Briefing (9/15/2020)

ADVANCING RESPECTFUL MATERNITY CARE FOR MEDICAID RECIPIENTS

Before I begin my formal comments, I’d like to thank Rep. Alma Adams and my personal shero, Rep. Lauren Underwood and the Black Maternal Health Caucus for co-sponsoring this important briefing with Community Catalyst, Every Mother Counts, March for Moms, Families USA, and my good friend Dr. Joia Crear-Perry and her team at the National Birth Equity Collaborative.

We are here today to talk about advancing respectful maternity care for Medicaid recipients during a global pandemic, another attempt at racial reckoning, and a potential recession spawned by COVID-19 all happening during an existing Black Maternal Health Crisis. If you remember nothing from me today, know this: None of this has to remain the way that it is AND This could all be different.

I want to make two points. FIRST: There are things we can and should make permanent that were spawned by the pandemic and SECOND: We need to decide if we are going to retrofit, reform or reimagine care for Medicaid recipients. I believe that if we center the people who experience the greatest burdens, care should improve for everyone. Let me repeat that. I believe that if we center the people who experience the greatest burdens, care should improve for everyone. Thus, reimagine in my goal, but retrofit and reform are necessary in the here and now.

Despite the botched public health response,

· We’ve sent clinicians across state lines — we couldn’t do that in the past, despite national licensure,

· We’ve seen the government provide a basic minimum income to its citizens,

· We’ve seen innovations in CMS payment for telehealth and

· We’ve seen mutual aid spur innovation.

My only disappointment is that it took a pandemic to make these things occur — What will it take for us to recognize essential changes we must make to ensure our existence in the future? What should remain permanent? I’ll give you one recent example: Mayor London Breed in San Francisco announced the “first of its kind” pilot program Monday that aims to address racial maternal health disparities and prevent premature births by increasing economic and community support for Black and Pacific Islander women in San Francisco. The Abundant Birth Project, a collaboration with the Expecting Justice initiative at the San Francisco Department of Public Health, will provide $1,000 a month to 150 Black and Pacific Islander expectant mothers in San Francisco. Mothers will receive unconditional aid throughout pregnancy and for six months after their babies are born.

Since COVID-19 hit our transdisciplinary team with researchers from UCSf OBGYN, Epi/Biostats and Nursing have successfully obtaining $1.37 million dollars in research dollars specific to COVID-19 work specific to BIPOC and queer folx and community engagement. All from foundations. To be clear, if we had functional public health infrastructure, no one would be writing grants during a global pandemic. And another point, we don’t know enough about pregnant people and how COVID-19 impacts them, layer on an already existing Black Maternal Health Crisis and I worry about the intergenerational impacts these two intersecting problems will create. This is why registry data are so important and representation matters. This is reform, finally Black investigators receiving funds to do work WITH community.

Data from our research group and others have shown that the mistreatment is rampant in healthcare and I will make the provocative point that no one else will make: Clinician Burnout and Patient Mistreatment are linked. It stems from a structural problem: Our workplaces are inhumane. Medicaid reimbursement rates are too low to sustain practices, so folx either over schedule tons of patients whose time is disrespected with long wait periods or people cut corners to get everyone seen. Too many people see Medicaid as an entitlement when we know health insurance is a simple intervention that improves health outcomes. Paid family leave is low hanging fruit that could be done right now — when else to pilot this, than a pandemic?

If we really believe that centering the people most burdened will improve care for everyone, we will reimagine care with, for and BY the people served by the Medicaid programs. I thank you for listening and look forward to our discussion.