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December 2025
Volume 12 | Issue No. 102
More than 42% of all births in the U.S. are
covered through Medicaid, making it the
largest single-payer of maternity care.
It's no secret that Medicaid comes with
deficits. In Missouri, pregnant people
whose births are covered through
Medicaid have a seven times higher
pregnancy-associated mortality rate than
individuals with private insurance. But even
with this disparity, Medicaid, especially in
expansion states, is providing more than a
safety net; it's saving lives.
According to analysis by Families USA,
maternal mortality rates are notably lower
in expansion states that have expanded
Medicaid coverage up to 138% of the
federal poverty level, compared with
nonexpansion states. Between 2019
and 2023, maternal mortality rates in
nonexpansion states were 35% higher than
those in expansion states. The analysis goes
on to pinpoint a 46% increase in maternal
deaths from 2020 to 2021 in nonexpansion
states, compared with a 21% increase
during the same period in expansion
states. Access to Medicaid, even with its
flaws and shortcomings, clearly saves lives.
Access to health insurance will be
tentative for many people who need it the
most, as House Republicans passed the
so-called One Big Beautiful Bill (OBBB) on
July 4.
Thanks to the bill, the Congressional
Budget Office projects roughly 10.9 million
people in the U.S. will find themselves
uninsured because of changes to both
Medicaid and the Affordable Care Act.
Other projections for coverage losses are
higher. By 2034, the CBO projects 16 million
people will be uninsured.
As for Missourians, the changes instigated
by the OBBB will increase the uninsured
population by an estimated range of
100,000 to 170,000 — the lion's share will
come from policy changes to Medicaid,
and about a third from changes to ACA.
Medicaid work requirements, reductions
in federal matching funds, and biannual
redetermination (six months vs. annual) are
a few changes that will shove hardworking
individuals off of these safety nets. This
includes 8 million women, 36% of whom
are of reproductive age.
With these cuts and health policy
changes, access barriers to both
mandatory and optional benefits are
inevitable.
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