Improving Health Care for Pregnant and Postpartum Individuals Act (2021)

 In this paper, I will be providing an explanation and overview of the Maternal Mortality Omnibus Bill, and how it has aimed to affect maternal health. This bill (which will be referred to as this MMOB for short from here on) may also be referred to as the, “Improving Health Care for Pregnant and Postpartum Individuals Act,” as that is a more specific name for it, whereas MMOB is a much more generic term. It was introduced by the Illinois General Assembly in 2021 and its main goal is to target concerns of high maternal mortality/morbidity rates in Illinois. Particularly, the bill is also meant to decrease the amount of obstacles that are in the way for some people to actually access care. In 2018, a report from the Illinois Department of Health demonstrated exactly that; the rates of maternal mortality and morbidity—especially among Black parents giving birth—were noticeably high, which prompted this bill to be written and passed.

This bill was specifically introduced by Senator Cristina Castro in February 2021, and signed by Governor J.B. Pritzker on August 27th, 2021. This bill demanded the Department of Human Services put more manpower and focus into its maternal child health programs to benefit pregnant and postpartum people, especially those considered high-risk. All of the services this bill outlines were designated to be distributed by licensed social workers, registered nurses, and/or other health professional staff with training in behavioral health.

There are several different specific goals this bill sets out to accomplish. One of which is making it easier for people to access long-acting reversible contraception in the hopes that there are fewer unplanned pregnancies, which would also have the effect of decreased mortality rates among birthing mothers. The bill outlines that it will force insurance plans to make the cost of long-acting reversible contraception (LARC) isolated from that of other postpartum services, which makes LARC more accessible for people to receive after having given birth. Another thing this bill aims to improve is new parents’ access to case management services, especially those of low-income or high-risk pregnancies, particularly relating to that of mental health and substance abuse treatment. These services include parenting guidance, teaching parents on child development, and exposing them to other resources that may be beneficial to them.

Guaranteeing coverage over needed in- and outpatient treatment services is yet another primary goal of this bill. The idea here is that it will help pregnant parents get the care that they require to have a healthy delivery, which will decrease the chance of her mortality. The last goal that will be covered here is the provision of 48-hours of inpatient treatment without any waiting times. This means that if a pregnant person needs to go to the hospital and get treatment right away, whether it be for detoxification or managing withdrawal, she may be able to, which will help treat and/or prevent many conditions or symptoms that could contraindicate pregnancy.

Through these goals alone, it is evident that this MMOB plays a massive role in progressing maternal health and survivability, especially in women of higher risk (whether biologically or systemically). This includes many women of minority ethnic and racial groups, as they are more often low-income and/or systematically disadvantaged compared to whites (especially relevant to note is worse healthcare). Because Black women are about six times more likely to experience maternal mortality than white women, this Bill aims to make that disparity a little less sizable. Especially by providing those case management resources and more forgiving access to inpatient hospital care, African American women, Hispanic women, and women and families of other racial backgrounds will face less adversity in getting adequate prenatal and postnatal care.

To add to this, unintended pregnancy rates are also much greater among women with lower income than those of middle or higher socioeconomic class. This bill’s focus on also improving accessibility to contraception and the affordability of it through insurance has played a role in making these rates go down. Greater unintended pregnancy rates equate to greater maternal mortality rate, so lowering the former will likely be successful in lowering the latter. Thus, the bill’s targeting of making contraception more available not only makes low-income individuals less likely to get unexpectedly pregnant via unprotected intercourse, but it also allows them to avoid deliveries carrying even the slightest bit of risk to the mother.

In conclusion, this Maternal Mortality Omnibus Bill is a policy change that has had the primary goal of improving the survival rate of women before, during and after childbirth. There is an apparent particular focus on women of low-income and women of color, as their maternal mortality rates are especially high, some of the provisions this bill includes are targeted towards benefitting them for the most part. Overall, by providing better means of obtaining contraception, immediate inpatient and outpatient treatment, and case management services, this policy change’s objective is to reduce the uneven differences to access to prenatal/postnatal healthcare in women of different demographics and to substantially improve the chance of survival and prosperous post-delivery health for all pregnant people in the state of Illinois.

Sources:

• Illinois Policies Affecting Public Health - EverThrive Illinois
• IDHS: Family Case Management (state.il.us)
• Maternal Morbidity and Mortality (illinois.gov)
• ilga.gov/legislation/publicacts/102/PDF/102-0665.pdf
• Bill Text: IL SB0967 | 2021-2022 | 102nd General Assembly | Engrossed | LegiScan
• Chapter 2: Advancing Maternal and Infant Health by Extending the Postpartum Coverage Period (macpac.gov)

A student proposes a national age limit of 25 for tobacco products.

    Throughout the history of tobacco products there has always been unavoidable side effects hidden from humans. Within the 20^th and 21^st centuries, the producers of tobacco products have created an upheaval in the numerous consumption options. The most popular of the various options for tobacco products include: cigarettes, light and menthol cigarettes, cigars and pipes, hookahs, and chewing tobacco. Along with these products, many tobacco companies and entrepreneurs have found their way into the most popular way of nicotine consumption in the 21^st century today, which is vaping. Vaping was originally invented to help those who are addicted to traditional tobacco products, but it has since changed to being a popular trend for those who have never been addicted before. The most concerning part of the vaping trend is that younger persons are becoming addicted. According to the Centers for Disease Control and Prevention, studies have shown that, “About 1 of every 20 middle school students (4.7%) reported in 2020 that they used e-cigarettes in the past 30 days…” and “About 1 of every 5 high school students (19.6%) reported in 2020 that they used electronic cigarettes in the past 30 days…” With this issue, I am proposing that the age of all tobacco and nicotine products be raised from the age of 21, which is what it is now, to the age of 25. By doing this it would target youths and young adults under the age of 25 and lower the rate of usage in the United States.

         The best way to target this issue is by making it a nationwide policy in the United States. By making this policy enforced by the law it will ultimately help with the access of these products being less available and harder to find for those under the age of 25. There were steps made to make this issue go away by making the legal age 21 instead of 18 has helped, but this age difference is not significant enough. A 25 year old will most likely not want to sell tobacco products to an 18 year old or even younger than that because it is uncomfortable. Yes, it is still possible for a multistep deal to take place if the age is raised to 25, but this would ultimately be inconvenient for all parties involved. By creating an inconvenience, this is going to help lower the rate of addiction within youths and young adults and overall help their health in the long run.

         Further examining the health risks that are caused by vaping, the most common knowledge one would have is that it has terrible effects on one's lungs. Because of the harmful chemicals that are put into the different vape products, the chemicals enter the bloodstream and go directly to the heart. It is becoming more common for death to occur because of this and youths and young adults are unaware of it. Not only is nicotine a popular form of vaping, but also many younger people use vapes that have THC in them which also have harmful side effects to the lungs and also the brain. According to the National Institute on Drug Abuse (NIH),  since the brain is not fully developed until the age of 25, exposure to tobacco before then can cause severe problems. “Upon entering the blood, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, breathing, and heart rate... Studies suggest that other chemicals in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.” (NIH). If these negative effects are happening regardless of one's age, it would be most beneficial for brains that are still developing to not be exposed to this in the way they are being now. 

On the opposing side however, there are potential reasons why raising the age would not be beneficial. The first issue many American’s would have a concern about is the loss of tax revenues. The average tax rate on a pack of cigarettes in the United States, according to tobaccofreekids.org, is $1.88-$4.35. By taking away a larger part of the tobacco user demographic, this would take away millions of dollars for the government and the tobacco companies. Another belief is that it will not matter what age the legal sales is, everyone under it will still find a way to feed their addictions. Like other things that are illegal until a certain age, youths and young adults will always find their way to getting what they want. There are other reasons that can be supported for this viewpoint, but the ones mentioned here are the most commonly addressed and discussed on this topic. 

Ultimately the idea of raising the legal age to 25 would help more than the people who are addicted to tobacco products. Parents and loved ones are becoming more aware of this issue and are constantly advocating for a change in this industry. I believe by launching a nationwide campaign for schools and colleges once the age is raised from 21 that it will have a big effect on stopping the increasing rate of addiction. Stopping the spread of underage tobacco use for the undeveloped brain would be beneficial for the future health of the American society. With that, it could also have a trickledown effect on the rest of the world and overall help everyone. The sooner we push out the campaigns on why tobacco use is causing deathly consequences, the sooner we can see the results of these horrific chances changing. Furthermore, ethically and medically it would make sense to change the legal age to 25 years old and creating better prevention strategies will help lead to a tobacco free future for our younger population. 

Works Cited

Centers for Disease Control and Prevention. (2020, December 16). Youth and Tobacco Use. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statis tics/fact_sheets/youth_data/tobacco_use/index.htm.  

National Institute on Drug Abuse. (2021, January 14). Tobacco/Nicotine and Vaping. National Institute on Drug Abuse. https://www.drugabuse.gov/drug-topics/tobacconicotine-vaping. 

States Should Not Increase Tobacco Use Age to 21. InsideSources. (2016, April 27). https://insidesources.com/states-should-not-increase-tobacco-use-age-to-21/#:~:text=The%20evidence%20shows%20increasing%20the%20age%20limit%20required,revenues,%20wasting%20police%20resources,%20and%20higher%20smoking%20rates. 

U.S. State and Local Issues: Tobacco Taxes. Campaign for Tobacco-Free Kids. (2020, December 28). https://www.tobaccofreekids.org/what-we-do/us/state-tobacco-taxes. 

This is a detailed and well-argued position.  I think that aside from tobacco and tobacco product producers, and some tobacco-product consumers who are comfortable with their addictions, most people probably agree with the idea that we ought to do something to reduce the use of tobacco products.  For motives we have the value of human life, and health life, and this is violated by products that contribute to more disease, earlier death, or other problems.  We also have a self-interest.  The costs of caring for persons sickened by tobacco products is usually shared by us all, through taxes that go to cover some costs, and insurance premiums that cover other costs. Since the various diseases and causes of death related to tobacco use tend to be more expensive than other forms of diseases that kills or disable us, we could save some money if fewer persons were addicted to disease-causing products.

This same argument applies to all substances that can cause addiction and disease.  We could make the same arguments against alcohol, and the logic would be about the same, even if the manifestation of injury to the health of users would differ.  Our problem is to decide what time of health-promotion policy is politically feasible, likely to be effective, is relatively efficient, and fits with our values.

With addicting products or other products that society considers morally dubious, we can add high taxes, and thus restrict access among those who are poorer, leaving only the wealthy the freedom to indulge or become addicted. The taxes can then be used to treat the health problems, or launch public health campaigns to reduce use.  We can ban the products.  We can restrict the ages of persons who have access to the products. We can impose other regulations to limit access to the products, or ensure that persons who consume the products are exposed to warnings or offers of help to address their presumed addictions.

Consider the various sorts of behaviors and products society may want to discourage:

Tobacco consumption
Alcohol consumption
Patronizing sex workers
Pornography consumption
Gambling
Off-label (recreational) use of addictive medications
Marijuana consumption
Opiate consumption
Hallucinogenic substance consumption
Cocaine and other stimulant consumption
Fossil fuel energy production
Production of excessive waste of resources or pollution

And so forth.

What are some of the various ways that seem to work best to discourage these things?

We can outlaw the behaviors, heavily tax, heavily regulate, carefully restrict, and in various ways use coercion and threats or confiscation to discourage.  

We can try to use prevention and social marketing to reduce the use or abuse of these things. That lets people make their own mind about what they want to do, but we can push society to be less accepting of these things.

If you can make money from it, there will always be people pushing to make these things legal, and popularize them. And if they remain illegal, or highly restricted, there will be people eager to make money dealing on a black market.

What are the relative advantages and disadvantages of the various approaches we use to controlling and discouraging these things? Why do we make some of these illegal, and others we simply restrict and regulate and tax?  

Student describes the COVID-19 Pandemic and policy responses to it

The New Corona Virus (SARS-CoV-2) causes the pandemic disease COVID-19, described by President Trump as the Chinese disease. It is a new virus, closely related to  In December the virus was transporting from person to person in China, and many cases were linked to a seafood market in Wuhan, China. On January 6, The Centers for Disease Control and Prevention warned Americans to take precautions if traveling to China. According to nbcnews.com/politics “The World Health Organization issues a statement about the first COVID-19 case outside of China, saying, “There is no clear evidence of human-to-human transmission.” On January 20, 2020 the first case was confirmed in the United States. The patient was seen at an urgent care clinic near Seattle Washington for a 4-day cold with fever. (NEJM Group) Radiography text were performed and showed no abnormalities and Influenzas test A and B was negative as well. Due to the patient's recent travel to China local and state health departments were immediately notified and had the patient tested for COVID. The patient’s specimens were collected from serum, nasopharyngeal, and oropharyngeal swab specimens. (NEJM Group) Patient) The patient’s nasopharyngeal and oropharyngeal swabs tested positive and on January 20, 2020 was the beginning of the COVID 19 outbreak in the United States. 

The Covid-19 outbreak led to many policies being created in the United States. One of Trump's executive orders banned anyone who had been in China 14 days prior with exceptions, including US citizens, lawful permanent residents, and their close family members.  On March 13, 2020, Governor J.B. Pritzker ordered all Illinois schools to be closed. Suddenly parents were without childcare and looking for alternative arrangements. This was one of the biggest orders announced to slow the spread of the coronavirus. Not too much later, President Trump issued orders to control the spread of the coronavirus at a press briefing. During the briefing, Trump recommended that all Americans, including the young and healthy, do schooling from home. He also wanted Americans to avoid gatherings in groups of more than ten people. I recall waiting to see if my daughters would perform in the St. Patrick's Day parade. At that time, most parents had no clue what the novel coronavirus was and didn’t know about the guidelines that should be followed. The city rescheduled the parade giving students a false hope that the show would go on, just not as scheduled. Parents were told the the St. Patrick's Day parade will be rescheduled and that they would receive information on the new dates.

However, downtowners were not caring about the coronavirus and packed the bars as ever, and enjoyed their usual good old time. Governor J.B. Pritzker along with other governors were upset that no one was taking social distancing seriously. The next policy that the governor dropped changed the economy. Governor J.B. Pritzker implemented a safety lockdown. This policy ordered all bars and restaurants in the state to close. Dining, malls, retail stores, and other small business were closed due to the stay-at-home order. The O'Hare International Airport was closed. This order was only to be to March 29, 2020. Unfortunately for the economy, the executive order went past that date and extended to the end of April.

The coronavirus not only affected the lives of Illinoisans, but it also affected life in America and across the globe. Life, as everyone had known it, came to a near halt in a matter of days. The unprecedented shutdown of activity in America caused some Americans to panic. Americans lined up in shopping centers and began to buy all the toilet paper, hand sanitizers, paper towels, feminine wipes, baby wipes, and groceries off the shelves. Americans were spending their savings on hoarding groceries and toilet paper. People were without work and a means to support themselves. The economy and stock market seemed to be doomed. Congress had to act and act fast to provide some type of relief to Americans. Measures were needed to support small business and people no longer working. This led to President Trump declaring the virus a national emergency and working with Congress on a relief package. The shutdown of America came with a price an $ 484 billion spending package to combat the coronavirus.

The policy included an enhanced unemployment package along with stimulus checks. The unemployment policy was signed into law on March 27, 2020. It provided enhanced unemployment insurance for workers, parents, and others impacted by the COVID-19 pandemic, who typically would not qualify unemployment benefits.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27. It expands states' ability to provide unemployment insurance for many workers impacted by the COVID-19 pandemic, including for workers who are not ordinarily eligible for unemployment benefits. There is no waiting period to receive unemployment other than the hundreds of people who filed ahead of you in line. In addition to regular unemployment benefits, individuals who receive unemployment receive $600 hundred a week from state unemployment insurance programs. Unemployment status would not affect the stimulus checks that were also approved by Congress. Most taxpayers and social security recipients were to receive  $1,200 per person in stimulus checks. The stimulus also included $500 dollars for each child. There is no confirmed news if the second round of stimulus checks will be issued. Illinoisans can only hope things get back to the way it was before the coronavirus.

References 

https://www.nbcnews.com/politics/donald-trump/timeline-trump-administration-s-response-coronavirus-n1162206 March 17, 2020,

Federal Register / Vol. 85, No. 58 / Wednesday, March 25, 2020 / Notices

https://www.npr.org/sections/goatsandsoda/2020/04/15/835011346/a-timeline-of-coronavirus-comments-from-president-trump-and-who

https://khn.org/morning-breakout/senate-overwhelmingly-passes-houses-coronavirus-bill-immediately-switches-attention-to-phase-3-stimulus-package/

NEJM Group Med 2020; 382:929-936 DOI: 10.1056/NEJMoa2001191