S-5515-119
Read twice and referred to the Committee on Finance. (text: CR S4998-5003)
Sponsored by Richard Durbin (D-IL)
What it does
The bill would require state Medicaid and CHIP programs to cover pregnant women through 12 months postpartum with full benefits and to cover oral health services. It would raise the federal share of costs for postpartum coverage (100 percent for the first 20 quarters, then 90 percent) and for rural obstetric services (90 percent), and bar states from making pregnancy eligibility rules more restrictive for 5 years. It would also create grants for perinatal quality collaboratives, doula training, regional implicit-bias education centers, and rural obstetric mobile health units, and would require hospitals to notify HHS 90 days before closing an obstetric unit. It would let states certify postpartum women for WIC for 2 years, require HHS reports and doula guidance, and raise federal excise taxes on roll-your-own, pipe, and smokeless tobacco (the text shown is cut off, so other tax changes are not visible).
Who benefits
Pregnant and postpartum women on Medicaid or CHIP, who would get 12 months of continuous coverage and dental care in states not already providing them. Rural women who may gain access through mobile units and the higher federal match for rural obstetric care. Doulas and trainees, state perinatal quality collaboratives, teaching hospitals and health schools receiving grants, and states that would get a higher federal match for postpartum costs. WIC-eligible mothers could be certified for longer, and communities facing obstetric unit closures would get advance notice.
Who is hurt
Manufacturers, importers, and consumers of roll-your-own, pipe, and smokeless tobacco, who would face substantially higher federal excise taxes. States would face administrative costs, must keep pregnancy eligibility rules in place for 5 years, and must pay their share of mandated dental and extended coverage after the enhanced match ends. Hospitals that plan to close obstetric units would face new reporting duties. Federal taxpayers would bear the added spending, and grant applicants not selected would not benefit.
Supporters argue
Supporters argue that the Centers for Disease Control and Prevention data cited in the findings show over half of maternal deaths occur 7 days to 1 year after delivery, while Medicaid coverage can lapse at 60 days, so continuous 12-month coverage targets a documented gap. They contend that funding collaboratives, doulas, and rural care, paid in part by tobacco taxes, addresses preventable deaths and sizable racial disparities with state-led, evidence-based tools.
Opponents argue
Opponents argue that turning the optional 12-month postpartum coverage into a mandate and adding dental benefits limits state flexibility and raises long-term Medicaid costs once the 100 percent federal match falls to 90 percent. They contend that the bill's authorizations of tens of millions of dollars per year, plus large tobacco tax increases that fall on consumers, add federal spending and burdens without proof that these programs reduce deaths.
Constitutional context
Congress acts under the Taxing and Spending Clause, and the tobacco provisions rest on its taxing power. Conditioning Medicaid funds on new state requirements raises the coercion question from NFIB v. Sebelius (2012), though the bill pairs its mandates with an enhanced federal match, a maintenance-of-effort condition, and a delay for state legislation.
Checks and balances
Congress gains influence over state Medicaid design and HHS gains grant and guidance authority; checks include annual appropriations for the authorized grants, HHS reporting to Congress, state legislative approval timelines, and judicial review of funding conditions.
Historical precedent
The American Rescue Plan Act of 2021 created a state option for 12-month postpartum Medicaid coverage, which this bill would make mandatory.