There was a lot of misleading information floating around a couple of years ago, when Missouri lawmakers considered expanding Medicaid.
There were incorrect assumptions about how long it would last, how much the state would have been on the hook for and what would be the state's responsibility if the federal government chose to change the rate it paid.
Five years after the U.S. government offered states - as part of the Affordable Care Act - the option to expand eligibility for Medicaid to people with incomes up to 138 percent of the federal poverty level, 36 states have taken the offer. The federal government continues to pay 90 percent of the cost of the expansion.
Missouri - which calls its Medicaid program Mo HealthNet - remains one of only 14 states that have not yet taken up the opportunity to expand programs. And recent reports indicate the states that have expanded have seen widespread health improvements for its neediest residents.
In a report released last week, Georgetown University Health Policy Institute Center for Children and Families found expansion improved the health of women of childbearing ages - 18-44 - and led to fewer deaths during childbirth. Women in the states that expanded had more access to preventive care and reduced adverse health outcomes before, during and after pregnancies, according to "Medicaid expansion fills gaps in maternal health coverage leading to healthier mothers and babies."
The report states women receiving a continuity of health coverage avoided adverse health conditions.
Research professor for the Center for Children and Families, Adam Searing was one of the report's authors. Searing said studies being produced kept coming up with the same outcome - there was a noticeable difference between expansion and non-expansion states.
Staff at the center decided to pull together all the research.
"It was really startling how clear it was that states that expanded Medicaid had a positive effect on mothers and infants," Searing said. "It was not just that you get to see doctors, you get screenings. It was this great drop in mortality - and a significant drop in infant mortality."
The majority of pregnancy-related deaths are avoidable, according to the report. A significant factor in preventing the deaths is making certain women receive proper medical coverage before pregnancy. And, states that have expanded have less "churn" - disruptive breaks in health coverage - that exacerbates existing health conditions.
Maternal mortality in the United States is higher than most other industrialized nations. The Central Intelligence Agency online world fact-book shows America's maternal mortality is tied with Puerto Rico for the 45th highest. Each of the countries had 14 maternal deaths for every 100,000 live births in 2015.
"We can focus on mothers. We can focus on getting better health care for mothers," Searing said. "And, we can focus on the health of babies. Other countries have been doing these things. But, we in the United States have not."
The differences between U.S. maternal mortality and that of other industrialized countries should give the United States the impetus to ask what it can do better, he said.
An added benefit to expansion of Medicaid to women of childbearing age is the improvement of children's health post-birth. Studies published in the American Journal of Public Health and Journal of the American Medical Association found states that expanded Medicaid had better health outcomes for infants. "Medicaid expansion and birth outcomes," written by Howard Bauchner, determined although the expansions did not have a significant effect on the number of pre-term deliveries or on low birth weights, there were improvements to African-American infants relative to white infants.
"Medicaid expansion is an important means of addressing persistent racial disparities in maternal health and maternal mortality," the Georgetown study stated.
Unfortunately, women in states that have not expanded Medicaid are less likely than those in states that have expanded to have any kind of medical insurance.
Before expansion, Missouri had the 28th-highest rate of women (ages 18-44) who were uninsured (19.6 percent). And although the state has improved its percentage (down to 13.9 percent), other states surpassed Missouri, and it has fallen to the 13th-highest rate of uninsured women.
Other improvements states that have expanded Medicaid are seeing are happening at community health centers.
Health centers are community-based organizations that deliver comprehensive care - oftentimes in communities where economic, geographic or cultural barriers limit access to affordable care services, according to the Health Resources & Services Administration's Health Center Program. They provide services regardless of patients' ability to pay and charge for services on sliding fee scales.
There are more than 1,300 federally qualified health centers (FQHCs) providing more than 11,000 sites across the nation. They provide care for one in every 12 people.
The Commonwealth Fund, created in 1918 with the goal of improving welfare for people, has for 100 years worked to improve health care and make it affordable and accessible for all Americans, according to the fund's website.
It conducted research and found that health centers have benefited from Medicaid expansion. In states that have expanded, centers were more likely to report improvements to their financial stability - 69 percent to 41 percent. They more often reported greater ability to provide affordable care for patients - 76 percent to 52 percent.
They were more likely to offer Medicaid-assisted treatment for opioid addiction - 44 percent to 25 percent.
And, they were more likely to report unfilled job openings for mental health professionals - 73 percent to 64 percent - and social service providers - 45 percent to 36 percent, according to the research.
Health centers in the states that did not expand coverage have not fared as well as their colleagues in states that did expand, according to the report.
They have fewer patients with insurance. Centers serve a disproportionate number of low-income, medically complex patients.
Centers in expansion states were more likely to participate in payment models in which they or their clinicians could receive financial incentives for attaining quality-of-care targets, according to the research.
As the safety net provider for low-income Americans, centers are key players in addressing patients' behavioral health problems.
Most centers surveyed in the research offered on-site, short-term counseling for patients. Those in expansion states are more likely to have provided the services.
The Georgetown report also noted a significant difference in the mortality rate between white women and women of color, Searing said.
Black women are three to four times more likely to be at a high risk of maternal mortality than white women, Searing said.
There are programs in place. There is federal money that is available to address the disparity in mortality between the races.
"Why should there be an inequity in how we treat women?" Searing asked. "We're not doing very well. That is unacceptable - to most people it would be."