Public health officials and lawmakers in Kentucky had been trying to address the complex issue of maternal mortality for years. Rep. Kimberly Moser had long been a neonatal and intensive care nurse, and knew the struggles around maternal health in the state. Lawmakers had taken steps in past sessions, but last year when the latest numbers came out, Moser decided it was time to bring the best minds together to finally improve the odds for Kentucky mothers and babies. The result of months of research and discussion yielded a range of solutions in a bill dubbed the “Momnibus.”
This is Across the Aisle, a podcast on bipartisanship from the National Conference of State Legislatures.
I’m Kelley Griffin
Kentucky Public health officials and lawmakers have been trying to address the complex issue of maternal mortality for years.
Kentucky Representative Kimberly Moser (mo-zher) had long been a neonatal and intensive care nurse and knew the struggles around maternal health in her state. Lawmakers had taken steps in past sessions, but last year when the latest numbers came out, Moser decided it was time to bring the best minds together to finally improve the odds for Kentucky mothers and babies.
Moser: “I’ve worked for a long time with families who had some health issues that were not addressed and they ended up with babies being born early. We saw plenty of babies who had the mom had prenatal care, they would not have had the outcomes we were dealing with.”
Moser sought out all the legislators who had sponsored bills in the past to address parts of the problem. It turned out the group was all women. And included both Senators and Representatives. And members of both parties. This bipartisan, bicameral group set to work last summer, starting with the data amassed by the Department of Public Health.
Moser: That became really a high priority, digging down on that, what does this mean? What can we do about it?
The list of causes and complications is long.
Moser: We have a problem with obesity and diabetes, heart disease, blood pressure related issues/// We also have a big substance use problem in Kentucky/ Mental Health was another factor that had not really been addressed in a comprehensive way.
Moser says the group determined the most effective way to help would be to get pregnant women connected to health care early and often. After months of research and discussion they wrote a bill to do this on several fronts.
Many of the women at risk are poor, so that got the group to look at beefing up Medicaid services.
Moser: I don’t want to generalize about anyone who has a certain health condition because certainly all of these health conditions can and do touch anyone, but our Medicaid population seems to be the area of probably a lack of education, a lack of finances, a lack of transportation. There are a lot of reasons why if you are living in poverty you’re not able to access care.
The state had already extended Medicaid coverage to the first year of a newborn’s life. The bill would expand an existing state program to ensure women get lots of support to have a healthy pregnancy. It adds lactation support, since breastfeeding is important to the health of mom and baby, but new mothers often struggle with it, and allows for telehealth appointments to reach more people.
The bill takes a page from a program in Massachusetts. It creates a hotline to give ob gyns expert advice for treating substance use or postpartum depression and to connect them with specialists and resources.
And the bill allows women to opt into or change their health insurance as soon as they learn they are pregnant. As it stands now, women aren’t eligible to revise their coverage until they HAVE a baby. The state doesn’t pay for the coverage, but it gives women the chance to obtain coverage to get full pre-natal care.
Moser: I know that the prenatal period is the best time to address some of these health conditions that moms may be dealing with, didn’t really understand maybe how important it was to get care of how this might impact or pregnancy or the outcome of the pregnancy
They called the package the State of Kentucky Moms Act, but everyone calls it the Momnibus.
Moser: We even have this great cardboard cutout of a school bus and it says ‘all aboard the momnibus,and it’s got the little windows, and we are taking it around, taking pictures. We’ve been promoting it, it’s a positive piece of legislation.
The bill IS getting strong support. Community organizations from Kentucky Right to Life to the ACLU are united on it. The House voted unanimously to support it and it appears likely to pass the Senate and has the support of Governor Andy Beshear, whose public health officials worked closely with Moser.
But Moser says it didn’t come easy. Not only did they have to understand the many root causes of the high maternal death rate in the state, they had to skirt around what one representative called “the elephant in the room.” Abortion. It could have derailed the bipartisanship if either side insisted the bill address that in some way.
Moser wasn’t going to let that happen.
Moser: I didn’t want to deal with that in this bill. We already have very strong pro-life legislation and laws in Kentuck. I just wasn’t willing to take on other big projects unless they were really germane to how we support the family in childbirth and having this new family.
One of the bill’s sponsors across the aisle, Louisville Democrat Lisa Willner, says it was a challenge at times.
Willner: I think all of us were pretty focused on these dismal statistics for our state and outcomes for pregnancy in Kentucky. I think that was really just nothing to do with party, it has nothing to do with ideology. It has everything to do with humanity.. So to reject that opportunity on ideological grounds probably didn’t make sense to any of us.
Willner notes even after the committee made a last-minute revision in the bill she didn’t particularly want to support, she stuck with it.
Willner: Having some many other really positive things in here that are evidence-based, that was in the spirit of compromise, willing to get past my questions and concerns and vote yes, a strong yes, on the bill.
To be sure, outside of this bill, they still are at odds around other bills related to pregnancy this session. Rep. Willner is used to being outvoted in the Kentucky legislature, where Republicans have a majority in both houses. But she’s keen to find bipartisanship wherever she can, whether joining forces on the Momnibus or adding a friendly amendment to a Republican-led effort.
She says she thinks it makes for better legislation, and she knows her constituents value it too.
Willner: And even in my very blue district I will say that my constituents love to hear about the bipartisan work. I think we are in an environment where conflicts are so heightened by the mainstream media also by social media and that conflict, people can get very caught up in it. But I think it’s exhausting for folks.And I think that when people hear about people coming together who hold deeply held, very disparate views and can still find the common ground, I think those are very important stories to tell.
Moser is well aware that, technically, she could have passed a bill without votes from Democrats. But she says she made a point to include a wide range of viewpoints in the working group
Moser: I think we get better policy when we bring a lot of voices to the table and that was really my thinking.
That’s our story today on Across the Aisle, I’m Kelley Griffin. Thank you for listening. I wanted to let you know that several states are taking steps to address maternal and infant health and we’re tracking all of it at NCSL.org.