Speaker Philip Gunn said he didn't know the human effects of killing a postpartum Medicaid extension bill. But top doctors say they gave him the details weeks ago. Credit: Eric J. Shelton/Mississippi Today

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Mississippi babies are more likely to die before their first birthday than infants anywhere else in the country. Mississippi has the highest preterm birth rate and the lowest birth weight rate in America, and one of every seven babies born here are preterm. Black babies are twice as likely to die as their white counterparts in Mississippi.

Mothers who give birth in Mississippi are more likely to die here than in 45 other states, with a pregnancy-related mortality rate nearly double the national average. A whopping 86% of pregnancy-related deaths occur postpartum, including 37% after six weeks. Black women are three times likelier than white women to die of a pregnancy-related cause.

These numbers are made worse because of the state’s high rates of poverty and uninsured people. Across Mississippi, about 65% of babies are born to mothers on Medicaid. Because of lag times in getting approved for coverage and a 60-day cutoff of postpartum care coverage, mothers often do not receive the prenatal and postpartum care they need — care that could prevent major problems.

Mississippi physicians, economists, mothers and children, and now a Republican appointed board of advisers all agree that lawmakers should make a single decision to save countless lives: extend Medicaid coverage from 60 days post-birth to one year. It would cost the state an estimated $7 million per year, a drop in the bucket as lawmakers sit on a record cash reserve of $3.9 billion.

But dismal statistics, expert testimony, sobering pleas of affected mothers, and clear life-saving benefits of extension be damned — one man, Speaker of the House Philip Gunn, is blocking it.

“I don’t see the advantage of doing the postpartum thing,” Gunn told reporters in December, saying he will only do it if the Mississippi Division of Medicaid recommends it. A spokesman for the state’s Medicaid department led by Drew Snyder, an appointee of Gov. Tate Reeves, told lawmakers in December the agency would not recommend for or against postpartum coverage.

“(Medicaid leaders) have not called me and told me that I’m wrong on that,” Gunn said.

Last year, a bill to extend postpartum coverage to 12 months had some serious momentum after a vast majority of senators voted to pass it. Senate Republicans, including the chamber’s president, Lt. Gov. Delbert Hosemann, called it “a no-brainer.”

But Gunn unabashedly killed it when it got to his chamber. He publicly claimed he had not seen data or been part of discussions showing that the extension would save lives. But that was not true, Mississippi Today reported. Just weeks earlier, five of the state’s major medical associations penned a letter to Gunn laying out the relevant data and directly stating that extending the program would save lives.

READ MORE: Doctors asked Speaker Philip Gunn to extend health coverage for moms and babies. Then he blocked it.

Gunn has also referenced his long-standing opposition to broader Medicaid expansion in defense of his decision to block the postpartum extension. That topic, long contentious in Mississippi and in other Republican-controlled states, is rife with its own distracting narratives, and health experts have implored lawmakers to keep the two separate issues separate. But that hasn’t stopped Gunn from playing that political card at every turn.

Looking around the House chamber, it quickly becomes apparent how Gunn could comfortably justify his decision to kill a bill that most directly affects Mississippi women and why there hasn’t been an uprising of lawmakers pleading with him to change his mind. In the chamber Gunn leads, just 15 members out of 120 current members (13%) are women. Just three of the 47 House committees of which Gunn appoints leaders are chaired by women.

The Senate’s statistics are better, but not by much. Just 10 senators out of 52 total (19%) are women. Hosemann has appointed six women to chair committees out of 44 total Senate committees.

In a state where 51% of the population is made up of women, just 15% of the entire state Legislature is made up of women. And with so few women in leadership positions, it’s tough to see a change in policy affecting women happening soon.

If you’re keeping track at home, here’s what has to happen to pass a widely supported and affordable plan to save or improve the lives of countless Mississippi mothers and their children: A majority of a group of 105 powerful men has to sign off, a majority of a group of 42 powerful men has to sign off, then a powerful man has to get the go-ahead from another powerful man, who likely has to get the blessing from his boss who is — you guessed it! — another powerful man.

Some are hoping a recommendation made last week by a committee of appointees from Reeves, Hosemann and Gunn himself could spur action on postpartum coverage. The 11-member Mississippi Medical Care Advisory Committee unanimously voted to recommend that the Legislature extend postpartum Medicaid coverage for new mothers from 60 days to 12 months.

Several proponents of the bill regularly note that Gov. Reeves could bypass the Legislature altogether and extend postpartum coverage himself with an executive order. But Reeves, who has long decried expansion of any federal Medicaid program, has given no indication that he supports the policy.

But in the Legislature, there’s always a chance. Several bills in both the Senate and the House have already been filed this session. Senate leaders, who spent the fall studying how to improve the lives of Mississippi women and children, vow to again pass the bill this session and send it to the House.

Notably, one of the 15 women in the House — a member of Gunn’s own Republican caucus — authored a postpartum extension bill and is publicly backing it.

“As a woman and as a mother, I couldn’t let this issue pass without advocating it and really trying to push it forward,” Rep. Missy McGee, a Hattiesburg Republican, told Mississippi Today last week. She said she supports extending the postpartum coverage to 12 months based on what she’s heard from health experts — including pediatricians, neonatologists and emergency medicine doctors from her district — and based on her experiences as a woman and a mother.

But if Gunn, the man who single-handedly controls every piece of legislation that comes through the House, continues to resist the proposal, McGee’s perspective may not mean a thing in the end.

Meanwhile, real Mississippi mothers and children across the state are suffering and could profoundly benefit from a little more help from their speaker and their government. 

READ MORE: After lawmakers choose not to extend postpartum Medicaid, six Mississippi moms speak out

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Adam Ganucheau, as Mississippi Today's editor-in-chief, oversees the newsroom and works with the editorial team to fulfill our mission of producing high-quality journalism in the public interest. Adam has covered politics and state government for Mississippi Today since February 2016. A native of Hazlehurst, Adam has worked as a staff reporter for AL.com, The Birmingham News and The Clarion-Ledger and his work has appeared in The New York Times, The Washington Post and Atlanta Journal-Constitution. Adam earned his bachelor’s in journalism from the University of Mississippi.