Florida has one of the highest uninsured rates for women of child-bearing age and continues to lag behind states that have expanded Medicaid, according to a new report.

The Georgetown University Center of Children and Families released a study Wednesday that showed the uninsured rate for women ages 18 to 44 in Florida is 19 percent, compared to the average of 9 percent in states that have opted for expansion of Medicaid, a federal and state program that helps cover medical costs for people with limited income and resources. The report found that Medicaid expansion played a role in reducing rates of maternal death, decreasing infant mortality rates and improving birth outcomes in those specific states. Florida is one of 14 states that has not expanded Medicaid.

"The U.S. has one of the highest rates of maternal mortality of industrialized countries in the world," said Adam Searing, the report's author. "Other countries have gotten better where we've gotten worse. There are stark racial disparities, too. African-American women are three times more likely to die from childbirth than white women, and the vast majority of these deaths are preventable."

A provision in the Affordable Care Act gave states the option to expand Medicaid eligibility to cover more low-income residents. While the federal government is financing most of the expansion, states must contribute more to the program. But the option was a non-starter in the conservative Florida House. And former Gov. Rick Scott flip-flopped on the idea, ultimately saying he worried the federal government would go back on its promise to fund the majority of the expansion.

States that have expanded Medicaid to all adults with an annual income of about $29,435 for a family of three, saw a 50 percent reduction in infant mortality rates compared to states like Florida that did not expand Medicaid, the report shows. The decline was the greatest among African-American infants. The report looked at data in all states from 2013 to 2017.

In Florida, the income threshold for Medicaid is about $6,825 for a family of three. Adults with no children nor any disabilities do not qualify for Medicaid benefits, no matter how poor. Women in Florida are generally covered once they become pregnant, but rarely before or after. In most cases, mothers lose coverage 60 days after giving birth.

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The American College of Obstetricians and Gynecologists recommends that women have access to health coverage before becoming pregnant and at least 12 months postpartum to reduce preventable adverse health outcomes.

"Health coverage before, during, and after pregnancy is essential to the health and well-being of both mother and child," said Joan Alker, executive director of the Center of Children and Families, a nonpartisan policy and research center founded in 2005 that examines health care coverage for children and families across the United States. It is part of Georgetown's McCourt School of Public Policy. "Medicaid expansion is the single most effective way to help women of childbearing age get continuous health coverage during this critical stage of life."

Alker went on to describe how health care can fluctuate rapidly for women as they fall in and out of care around a pregnancy. States that have expanded Medicaid saw larger decreases in those gaps of coverage, she said.

"Any policy that will help boost the health of Florida mothers and infants should be a top priority for state lawmakers," said Sadaf Knight, CEO of the Florida Policy Institute in Tallahassee. "Not only would expanding Medicaid help more than 500,000 low-income residents access health care services — our state would receive $9 in federal funds for every $1 we invest, meaning that more state dollars would be freed up to invest in other areas."

The research also examined how health coverage prior to pregnancy had an impact on other risk factors for women, such as obesity, diabetes and heart disease.

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Center of Children and Families researchers went on to criticize Florida for a proposed bill in Florida's House of Representatives (House Bill 955) that would have required an estimated 500,000 Medicaid beneficiaries to work or show they are trying to get jobs to keep their health-care benefits. Several recent court rulings struck down similar requirements. The bill passed in the House, but was not passed by the Senate during the 2019 legislative session.

"Not only has Florida not expanded Medicaid, the Florida House passed one of the worst Medicaid work requirements I've seen across the country," Akler said. "Without Medicaid expansion, it will be near impossible to see sharp improvements for women."

Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.