The phrase “family values” is familiar to anyone within earshot of Texas’s Republican leaders such as Governor Greg Abbott or Lieutenant Governor Dan Patrick—the politicians connect the popular conservative idea to many of their agenda items, showcasing its malleability to match the hot-button issues of the day. Most recently, in Texas, “family values” have been called into service in battles over library books, attempts to restrict gender-affirming care for transgender children, and one of the country’s strictest abortion bans. But some faith-based organizations and women’s health advocates are pushing for a version of family values that is less about state enforcement of a specific religious ideal and more about tangible support for families—what personal financial advisers call “values-based budgeting.”
“Texas is really cocky when saying that we uphold family values,” said Cessilye R. Smith, CEO of Abide Women’s Health Services in Dallas. “We’re really confident, but we seem to be behind the ball when it comes to offering practical, tangible, and sustainable support to pregnant people.” With a maternal mortality rate almost five times the national average and the highest uninsured rate in the country for women of childbearing age, Texas has a way to go before it has receipts on its family values. A first step forward, Smith said, would be to pass a law that would allow women to stay on Medicaid for a full year after the end of pregnancy.
Smith joined the Center for Public Justice for a prayer and learning meeting on May 2, as the faith-based public policy organization speaks out in support of Medicaid expansion along with the Texas Baptist Christian Life Commission and other supporters. In April, the Texas Senate received House Bill 12 from the lower chamber, which, if passed, would enact the extension.
“Christian tradition honors family life. It celebrates it,“ said Rachel Anderson, a fellow with the faith-based Center for Public Justice and strategic adviser to its Families Valued program, speaking to Texas Monthly. “We believe that family is worthy work, and therefore must be supported.”
For the nearly half a million Texans enrolled in pregnancy Medicaid, the extension would alleviate some of the undeniable cost of welcoming a newborn, a cost that has been undermining the “pro-life” agenda for decades. Whether you define pro-life in the narrowest sense to mean antiabortion, or the broadest sense to mean substantial support of human thriving, the financial and physical cost of pregnancy and postpartum health care is a hurdle.
For all of the confusion and chaos the antiabortion movement has wrought in Texas, the stated goal of Texas’s abortion ban is simple: for the approximately 50,000 to 55,000 pregnancies aborted yearly in Texas to end instead in live births. That is a lot of new babies on top of an already booming newborn population. If the ban were to be totally successful on its proponents’ terms—meaning women did not travel to other states or procure abortion pills via telemedicine—statistics indicate that almost half of those babies will be born to mothers who feel they cannot afford to support them. Nationally, financial strain is the most common reason women give for seeking an abortion, at around 40 percent. In Texas, many of those are likely among the 24 percent of uninsured women between the ages of 15 and 44—the highest rate in the country. Texas has done more than most states to end abortion, but less than most to support mothers, and thus, their newborn babies.
“We always say if you want to have healthy babies you have to have healthy moms,” said Diana Forester, director of health policy for Texans Care for Children, a nonprofit dedicated to exactly what it sounds like. Health care between pregnancies is also the best way to ensure healthy subsequent pregnancies, she said.
The state can do something for financially vulnerable women who no longer have access to abortion, lose pregnancies due to health complications, or increase their risk of health complications and death not just during and immediately after pregnancy, but for the entire year following delivery. The Texas Maternal Mortality and Morbidity Review Committee, established by the Legislature as a task force in 2013, reported that in 2019, nearly a third of the pregnancy-related deaths occurred between 43 days and a year after delivery. Pregnancy-related deaths can be related to hypertension, embolism, infection, and mental health conditions, and the committee concluded that 90 percent were preventable. It recommended increasing access for a full year after delivery, along with community-specific public health outreach efforts to address the racial disparities in maternal mortality. For women who aren’t seeing a doctor regularly, or can’t afford to pay out of pocket to have their early symptoms checked out, the conditions go untreated until it’s too late. In the fog of sleep deprivation, breastfeeding, and hormonal fluctuations, “it’s easy to brush off the symptoms,” Forester said.
The anxiety of knowing that they can’t afford health care increases harmful stress for new parents, but there’s a beneficial inverse, Smith said. “Just having the security and knowing that you have health care for that whole first year after pregnancy strips off a layer of weathering for women and birthing people.”
Until the pandemic, Medicaid coverage for pregnant women in Texas ended two months postpartum. No one was removed from Medicaid for as long as the COVID-19 emergency lasted. With the emergency declaration set to end this month, states have begun reevaluating participants’ eligibility and moving many off Medicaid. To ease the transition, the federal government included a provision in the American Rescue Plan Act to allow states to extend coverage for a year after a pregnancy ends, with the fed picking up the majority of the cost. Texas is one of about ten states that has not adopted the extension, something House Bill 12 aims to change. Last session a similar bill was cut in half by the state Senate, allowing for six months postpartum coverage, but the federal government has not approved the modified plan.
Medicaid is a good plan, without high deductibles, said Forester. “It’s a safety net. It saves lives.” The grim data suggest that Texas mothers are in need of such a lifesaving safety net. So are their children. Research published by the American Academy of Pediatrics showed that increased Medicaid coverage for parents resulted in increased well-child visits for children—and all children benefit from having healthy parents.
“Families are foundational to a healthy society. If moms are deferring their own health care, it limits what they can do for their children,” Anderson said. The need for parental engagement and community support is intensive in the first year and “can have an impact on a child’s whole development.”
When that support is taken away by health crises, postpartum depression, or death, children are robbed of the nurture that developmental science deems critically important. Listening to the rhetoric from conservative politicians, you’d think that they would agree. The role of parents, mothers in particular, in the life of the child is foundational to their entire argument. There’s an irony to undermining the health of a group deemed essential to a family-first vision for Texas. “If a mother goes down it affects everyone in the house,” Smith said. “We have to value women more.”