[Congressional Record Volume 167, Number 82 (Wednesday, May 12, 2021)]
[House]
[Pages H2215-H2217]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROTECTING MOMS WHO SERVED ACT
Mr. TAKANO. Madam Speaker, I move to suspend the rules and pass the
bill (H.R. 958) to codify maternity care coordination programs at the
Department of Veterans Affairs, and for other purposes.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 958
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protecting Moms Who Served
Act''.
SEC. 2. SUPPORT FOR MATERNITY CARE COORDINATION.
(a) Program on Maternity Care Coordination.--
(1) In general.--The Secretary of Veterans Affairs shall
carry out the maternity care coordination program described
in Veterans Health Administration Handbook 1330.03, or any
successor handbook.
(2) Training and support.--In carrying out the program
under paragraph (1), the Secretary shall provide to community
maternity care providers training and support with respect to
the unique needs of pregnant and postpartum veterans,
particularly regarding mental and behavioral health
conditions relating to the service of the veterans in the
Armed Forces.
(b) Authorization of Appropriations.--There is authorized
to be appropriated to the Secretary $15,000,000 for fiscal
year 2022 for the maternity care coordination program. Such
amounts are authorized in addition to any other amounts
authorized for such purpose.
(c) Definitions.--In this section:
(1) The term ``community maternity care providers'' means
maternity care providers located at non-Department facilities
who provide maternity care to veterans under section 1703 of
title 38, United States Code, or other provisions of law
administered by the Secretary of Veterans Affairs.
(2) The term ``non-Department facilities'' has the meaning
given that term in section 1701 of title 38, United States
Code.
SEC. 3. REPORT ON MATERNAL MORTALITY AND SEVERE MATERNAL
MORBIDITY AMONG PREGNANT AND POSTPARTUM
VETERANS.
(a) GAO Report.--Not later than two years after the date of
the enactment of this Act, the Comptroller General of the
United States shall submit to the Committees on Veterans'
Affairs of the Senate and the House of Representatives, and
make publicly available, a report on maternal mortality and
severe maternal morbidity among pregnant and postpartum
veterans, with a particular focus on racial and ethnic
disparities in maternal health outcomes for veterans.
(b) Matters Included.--The report under subsection (a)
shall include the following:
(1) To the extent practicable--
(A) the number of pregnant and postpartum veterans who have
experienced a pregnancy-related death or pregnancy-associated
death in the most recent 10 years of available data;
(B) the rate of pregnancy-related deaths per 100,000 live
births for pregnant and postpartum veterans;
(C) the number of cases of severe maternal morbidity among
pregnant and postpartum veterans in the most recent year of
available data;
(D) the racial and ethnic disparities in maternal mortality
and severe maternal morbidity rates among pregnant and
postpartum veterans;
(E) identification of the causes of maternal mortality and
severe maternal morbidity that are unique to veterans,
including post-traumatic stress disorder, military sexual
trauma, and infertility or miscarriages that may be caused by
such service;
(F) identification of the causes of maternal mortality and
severe maternal morbidity that are unique to veterans from
racial and ethnic minority groups and other at-risk
populations as deemed appropriate;
(G) identification of any correlations between the former
rank of veterans and their maternal health outcomes;
(H) the number of veterans who have been diagnosed with
infertility by Veterans Health Administration providers each
year in the most recent five years, disaggregated by age,
race, ethnicity, sex, marital status, sexual orientation,
gender identity, and geographical location;
(I) the number of veterans who receive a clinical diagnosis
of unexplained infertility by Veterans Health Administration
providers each year in the most recent five years; and
(J) the extent to which the rate of incidence of clinically
diagnosed infertility among veterans compare or differ to the
rate of incidence of clinically diagnosed infertility among
the civilian population.
(2) An assessment of the barriers to determining the
information required under paragraph (1) and recommendations
for improvements in tracking maternal health outcomes among
pregnant and postpartum veterans--
(A) who have health care coverage through the Department;
(B) enrolled in the TRICARE program;
(C) who are eligible to use the Indian Health Service,
Tribal health programs, or urban Indian health organizations;
(D) with employer-based or private insurance;
(E) enrolled in the Medicaid program; and
(F) who are uninsured.
(3) Recommendations for legislative and administrative
actions to increase access to mental and behavioral health
care for pregnant and postpartum veterans who screen
positively for maternal mental or behavioral health
conditions.
(4) Recommendations to address homelessness, food
insecurity, poverty, and related issues among pregnant and
postpartum veterans.
(5) Recommendations on how to effectively educate maternity
care providers on best practices for providing maternity care
services to veterans that addresses the unique maternal
health care needs of the veteran population.
(6) Recommendations to reduce maternal mortality and severe
maternal morbidity among pregnant and postpartum veterans and
to address racial and ethnic disparities in maternal health
outcomes for each of the groups described in subparagraphs
(A) through (E) of paragraph (2).
(7) Recommendations to improve coordination of care between
the Department and non-Department facilities for pregnant and
postpartum veterans, including recommendations to improve--
(A) health record interoperability; and
(B) training for the directors of the Veterans Integrated
Service Networks, directors of medical facilities of the
Department, chiefs of staff of such facilities, maternity
care coordinators, and staff of relevant non-Department
facilities.
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(8) An assessment of the authority of the Secretary of
Veterans Affairs to access maternal health data collected by
the Department of Health and Human Services and, if
applicable, recommendations to increase such authority.
(9) To the extent applicable, an assessment of potential
causes of or explanations for lower maternal mortality rates
among veterans who have health coverage through the
Department of Veterans Affairs compared to maternal mortality
rates in the general United States population.
(10) Any other information the Comptroller General
determines appropriate with respect to the reduction of
maternal mortality and severe maternal morbidity among
pregnant and postpartum veterans and to address racial and
ethnic disparities in maternal health outcomes for veterans.
SEC. 4. DEFINITIONS.
In this Act:
(1) Maternal mortality.--The term ``maternal mortality''
means a death occurring during or within a one-year period
after pregnancy, caused by pregnancy-related or childbirth
complications, including a suicide, overdose, or other death
resulting from a mental health or substance use disorder
attributed to or aggravated by pregnancy-related or
childbirth complications.
(2) Postpartum and postpartum period.--The terms
``postpartum'' and ``postpartum period'' refer to the 1-year
period beginning on the last day of the pregnancy of an
individual.
(3) Pregnancy-associated death.--The term ``pregnancy-
associated death'' means a death of a pregnant or postpartum
individual, by any cause, that occurs during, or within 1
year following, the individual's pregnancy, regardless of the
outcome, duration, or site of the pregnancy.
(4) Pregnancy-related death.--The term ``pregnancy-related
death'' means a death of a pregnant or postpartum individual
that occurs during, or within 1 year following, the
individual's pregnancy, from a pregnancy complication, a
chain of events initiated by pregnancy, or the aggravation of
an unrelated condition by the physiologic effects of
pregnancy.
(5) Racial and ethnic minority group.--The term ``racial
and ethnic minority group'' has the meaning given such term
in section 1707(g)(1) of the Public Health Service Act (42
U.S.C. 300u-6(g)(1)).
(6) Severe maternal morbidity.--The term ``severe maternal
morbidity'' means a health condition, including mental health
conditions and substance use disorders, attributed to or
aggravated by pregnancy or childbirth that results in
significant short-term or long-term consequences to the
health of the individual who was pregnant.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
California (Mr. Takano) and the gentleman from Illinois (Mr. Bost) each
will control 20 minutes.
The Chair recognizes the gentleman from California.
General Leave
Mr. TAKANO. Madam Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and to insert extraneous material on H.R. 958.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. TAKANO. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, the United States is the only industrialized nation
where the maternal mortality rate is on the rise, and we have one of
the highest rates of maternal mortality in the developed world.
Black, American Indian, and Alaska Native moms die from complications
from pregnancy at approximately three times the rate of White, Latina,
Asian-American, and Pacific Islander women, regardless of income or
education levels.
Today, women veterans are the fastest-growing cohort in the veteran
population, and more than 40 percent of women veterans using VA for
their healthcare are of reproductive age. Black women serve in high
numbers and represent nearly one-third of women using VA for their
healthcare.
The Protecting Moms Who Served Act, introduced by Congresswoman
Lauren Underwood, would codify maternity care coordination in law and
provide additional resources to the Department of Veterans Affairs to
ensure that veterans receive the best prenatal and postpartum care
possible.
Madam Speaker, we do not yet know if pregnant veterans have better,
worse, or equal rates of maternal mortality compared to nonveterans.
This bill would address this knowledge gap by requiring the Government
Accountability Office to conduct a comprehensive study on maternal
mortality and morbidity among veterans.
This study would not only examine racial and ethnic disparities in
maternal mortality and morbidity but also would seek to capture data
from Federal programs besides VA, including TRICARE and Medicaid as
well as the Indian Health Service, private insurance, and the
uninsured.
While there is not yet enough data to make an authoritative
conclusion, there is some evidence that veterans who use VA have lower
maternal mortality rates than nonveterans. The study mandated by this
bill would identify what best practices VA has implemented that result
in better maternal health outcomes.
Madam Speaker, last year, approximately 6,000 veterans using VA
became new moms. Moms who have served our Nation exemplify strength and
resilience. Supporting moms means ensuring gender equity, and that
begins with health equity. I, therefore, ask my colleagues to join me
in supporting the Protecting Moms Who Served Act.
Madam Speaker, I reserve the balance of my time.
Mr. BOST. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise today in support of H.R. 958, the Protecting
Moms Who Served Act.
Just 3 days ago, we celebrated Mother's Day, so it is particularly
fitting to be here to discuss a bill to improve the care that is
provided to veteran mothers.
Women are volunteering to serve in uniform at a rapid rate, and when
they become veterans, they seek VA healthcare at a rapid rate as well.
I am committed to making sure the VA is equipped to provide them with
the high-quality care that they have earned.
The Protecting Moms Who Served Act will strengthen VA's maternity
care coordination program. It will expand training on the physical and
mental health needs of pregnant and postpartum veterans. It will also
require a GAO assessment of maternal health outcomes among women
veterans.
I am grateful to the bill's sponsor and my fellow Illinoisan,
Congresswoman Underwood, for introducing this bipartisan bill. I am
pleased to support it this afternoon.
Madam Speaker, I reserve the balance of my time.
{time} 1300
Mr. TAKANO. Madam Speaker, I yield 2 minutes to the gentlewoman from
California (Ms. Brownley), my good friend and chairwoman of the
Subcommittee on Health, and also the cosponsor of this important piece
of legislation.
Ms. BROWNLEY. Madam Speaker, I rise today in support of H.R. 958, the
Protecting Moms Who Served Act, which I was proud to co-lead with
Congresswoman Underwood, Congressman Bilirakis, and Congressman
Fitzpatrick.
Madam Speaker, this bill will ensure that veterans get the high-
quality maternal care they have earned by codifying the Maternity Care
Coordination Program. Additionally, this bill will require the GAO to
report on maternal mortality and morbidity among veterans.
I thank the chairman for his support on this issue, and I am proud
that this bill passed the committee with broad bipartisan support.
Madam Speaker, as you may know, among developed countries, the United
States has one of the highest maternal mortality rates in the world,
with an average rate of 17.2 deaths per 100,000 live births.
For women of color, the rates are even higher. For Black women, the
maternal mortality rate is 41.7 deaths per 100,000. And for American
Indian and Alaska Native women, it is 28.3 deaths per 100,000 live
births. More than 50 percent of pregnancy-related deaths happen after
delivery.
Today, there are 2 million women veterans living in the United
States, and women comprise the fastest growing subpopulation of both
the military and veteran populations, yet many of their health needs go
unaddressed in a VA system that has not evolved to equitably serve a
rapidly changing population.
As the chairwoman of the Women Veterans Task Force and chair of House
Veterans' Affairs Subcommittee on Health, I am proud to join
Congresswoman Underwood, who has truly,
[[Page H2217]]
truly been a champion--she is the founder and co-chair of the Black
Maternal Health Caucus--in fighting to end disparities in maternal care
for women veterans. Our veterans have sacrificed so much for our
country. It is past time that we address this inequity.
Madam Speaker, I urge my colleagues to support our women veterans and
vote ``yes'' on H.R. 958.
Mr. BOST. Madam Speaker, I yield 3 minutes to the gentleman from
Florida (Mr. Bilirakis), my good friend.
Mr. BILIRAKIS. Madam Speaker, I thank Ranking Member Bost and
Chairman Takano for their leadership. This bill is very important.
Madam Speaker, I rise in strong support of the Protecting Moms Who
Served Act, which I co-lead with my colleague and friend, Lauren
Underwood. I also thank Representative Underwood for her efforts on
this bill to help ensure that all female veterans have access to the
maternal healthcare and support they need and deserve.
Our Nation's heroes deserve the best possible care, and this
legislation gets us one step closer to achieving that goal. Women are
currently the fastest growing group within the veteran population,
creating the greatest demand for maternity care ever faced by the VA.
I have heard from my local VA medical centers about the growing
challenges they face in providing maternity coordination for female
veterans. The demand on this maternity coordination process has
significantly increased over the past few years, from an average of 50
patients per year to now around 140, featuring a generally higher risk
patient population than the private sector.
My local veterans medical centers said that the additional program
support and additional maternity care coordinators would be crucial in
meeting the growing demand, which this bill will provide.
The bill will also provide community maternity care providers with
training and support with respect to the unique needs of pregnant and
postpartum veterans, particularly regarding mental and behavioral
health conditions in relation to the service of the veterans in the
Armed Forces--very important.
Madam Speaker, these veterans honorably served our country. It is
only right that we provide the quality maternity care and support they
deserve.
Madam Speaker, again, I urge my colleagues to support this particular
bill.
Mr. TAKANO. Madam Speaker, I yield as much time as she may consume to
the gentlewoman from Illinois (Ms. Underwood), my good friend and
author of this bill, and a member of the Veterans' Affairs Subcommittee
on Health.
Ms. UNDERWOOD. Madam Speaker, I rise today in strong support of H.R.
958, the Protecting Moms Who Served Act, my bipartisan bill to address
maternal mortality among veterans that I proudly introduced with
Representative Gus Bilirakis and Julia Brownley and Brian Fitzpatrick.
Madam Speaker, the United States is currently confronting a maternal
health crisis. We have the highest maternal mortality rate in the
developed world and significant racial and ethnic disparities in
maternity health outcomes.
Some of the drivers of maternal mortality and morbidity can even be
more common in women who serve. For example, one in three women
veterans report that they experience military sexual trauma, which is
linked with risk factors for pregnancy-related complications. With
unacceptable maternal mortality rates for all U.S. mothers and unique
risks for veterans, we must ensure that the VA is providing the highest
quality maternal healthcare and support to moms who serve.
My bipartisan Protecting Moms Who Served Act would codify VA's
maternity healthcare and coordination programs, which offers screenings
and treatments to pregnant veterans with mental health conditions and
include measures to strengthen community partnerships with
organizations that support new parents.
The VA's maternity care coordination programs have been successful in
ensuring that veterans can receive high-quality, culturally appropriate
care and robust support throughout pregnancy, during labor and
delivery, and for the full yearlong postpartum period and beyond. By
codifying and strengthening these programs, veterans will continue to
receive the world-class care and support that they have earned.
The Protecting Moms Who Served Act would also invest in trainings for
community maternity care providers so that nurses, midwives, and
physicians caring for pregnant and postpartum veterans understand the
unique needs of veteran patients, particularly related to mental and
behavioral health conditions that might have been caused or exacerbated
by military service or the transition back to civilian life. These
trainings will ensure that veterans receive care that is responsive to
the lingering physical and psychological impacts of their service.
Finally, my bill will commission the first-ever comprehensive study
of maternal mortality, morbidity, and racial and ethnic disparities for
veterans. By having a complete understanding of the ways in which our
Nation's maternity health crisis extends to our veteran population, we
can develop evidence-based solutions to improve outcomes and save
veterans' lives.
Madam Speaker, I urge my colleagues on both sides of the aisle to
support the Protecting Moms Who Served Act. I thank the chairman of the
House Committee on Veterans' Affairs, Chairman Takano, for his
leadership to advance this critically important bipartisan
legislation--the first bill in our Black Maternal Health Momnibus Act
to be considered here in the House.
As a cofounder and co-chair of the Black Maternal Health Caucus, I am
committed to advancing each bill in the Momnibus to save moms' lives
and support families.
Madam Speaker, finally, I would also really like to thank--truly, it
has been a pleasure to work with--Representative Bilirakis,
Representative Brownley, Representative Fitzpatrick, and Ranking Member
Bost. Thank you for co-leading this bill with me.
Mr. BOST. Madam Speaker, I encourage my colleagues to support this
bill, and I yield back the balance of my time.
Mr. TAKANO. Madam Speaker, I yield myself the balance of my time.
Madam Speaker, I am delighted that we are taking this significant
step in addressing the terrible mortality rates that we are facing
among our Nation's moms, especially our moms of color. And to the
extent that we can shed light on this issue through this very important
legislation being brought forward by Ms. Underwood and Ms. Brownley, I
think that this is truly, truly a tremendous step forward.
Madam Speaker, I urge all my colleagues to vote in favor of this
legislation, and I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from California (Mr. Takano) that the House suspend the rules
and pass the bill, H.R. 958.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill was passed.
A motion to reconsider was laid on the table.
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