Across the Aisle | ‘Momnibus’ Bill Would Address Kentucky’s Maternal Mortality Crisis

Kentucky has the nation's second-highest rate of maternal death. Women die during and after pregnancy from high blood pressure, substance use, depression and diabetes.

Black women are three times more likely to die in childbirth than white women. And a state report found that 90% of the deaths are preventable.

Public health officials and lawmakers have been trying to address the complex issue for years. Rep. Kimberly Moser, a Republican and longtime neonatal and intensive care nurse, decided 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 the Save Kentucky Moms Act, affectionately known as the "Momnibus."

"I think we get better policy when we bring a lot of voices to the table."

-Kentucky Rep. Kimberly Moser

"We even have this great cardboard cutout of a school bus, and it says 'All aboard the Momnibus!'" Moser says. "We are taking it around, taking pictures. It's a positive piece of legislation."

Moser sought out all the legislators who had sponsored bills in the past to address parts of the problem-a group that included senators and representatives from both parties, all of whom are women. This bipartisan, bicameral group set to work last summer, starting with data amassed by the state Public Health Department. 

"That became really a high priority, digging down on that, what does this mean? What can we do about it?" Moser says.

The list of causes and complications is long. 

"We have a problem with obesity and diabetes, heart disease, blood pressure-related issues," Moser says. "We also have a big substance use problem in Kentucky, (and) mental health was another factor that had not really been addressed in a comprehensive way."

Connecting Women to Health Care

Moser says the group determined the most effective way to help would be to get more women connected to health care early and often in their pregnancies. Many of the women at risk are poor, so the group looked at beefing up Medicaid services. Moser says people on Medicaid face particular obstacles to care, including money, transportation and lack of knowledge about options. 

The state had already extended Medicaid coverage to the first year of a newborn's life. The Momnibus 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 the bill allows for telehealth appointments to reach more people.

The bill also takes a page from a program in Massachusetts, the Child Psychology Access Program for Moms. 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 in to 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 insurance, but it gives women the chance to obtain coverage to get full prenatal care.

"I know that the prenatal period is the best time to address some of these health conditions that moms may be dealing with when they didn't really understand maybe how important it was to get care, how this might impact the pregnancy or the outcome of the pregnancy," Moser says.

Broad Support

The bill is getting broad support. Community organizations from Kentucky Right to Life to the ACLU are united on it. The House passed it unanimously, and it appears likely to pass the Senate. It has the support of Gov. Andy Beshear, whose public health officials worked closely with Moser.

But the Momnibus approach didn't come easy, Moser says. The lawmakers had to not only understand the many root causes of the high maternal death rate in the state, but also 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.

"I didn't want to deal with that in this bill. We already have very strong pro-life legislation and laws in Kentucky," she says. "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 from across the aisle, Louisville Democrat Lisa Willner, says it was a challenge at times, but the working group held together in the face of Kentucky's dismal statistics. 

"I think (the bill) was really just nothing to do with party; it has nothing to do with ideology. It has everything to do with humanity," Willner says. "So to reject that opportunity on ideological grounds probably didn't make sense to any of us." 

"I think (the bill) was really just nothing to do with party; it has nothing to do with ideology. It has everything to do with humanity."

-Kentucky Rep. Lisa Willner

To be sure, outside of this bill, they still are at odds over other bills related to pregnancy this session. 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 where she can, whether joining forces on the Momnibus or adding a friendly amendment to a Republican-led effort. 

She says it makes for better legislation, and she knows her constituents value it, too. 

"And even in my very blue district I will say that my constituents love to hear about the bipartisan work," Willner says, noting how much discord can be found on social media and in the news. "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: "I think we get better policy when we bring a lot of voices to the table."

Editor's note: The Momnibus made it through the House with strong support from both parties, Gov. Andy Beshear and the community. But amendments in the Senate brought the abortion issue into play when lawmakers added language regarding palliative care for fetuses. That threw the bipartisan support into question and meant Beshear might veto the bill. The Senate wouldn't have the chance to overturn a veto because the vote didn't happen by a March 27 deadline. Legislators have only a few days left in the session after they return April 10 and conclude their work on April 15.

More than half the states are now considering a variety of approaches to lower the risk of maternal death and improve infant health, and NCSL is tracking legislation as it passes.

Kelley Griffin is the host of NCSL's Across the Aisle podcast.

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