At the Health Foundation for Western & Central New York, our vision for a healthy western and central New York includes healthy pregnancies, infants, and early childhood. Investing in a strong safety net through increased funding improves maternal health outcomes and also supports the well-being of infants and their ability to enjoy a healthy childhood.
That’s why we are especially concerned with the looming changes to health care access because of federal legislation like H.R.1. Among developed nations, the United States has the highest maternal mortality rates. Each year, for every 100,000 live births, 18.6 mothers die. It’s a trend that began in the 1990s and has generally gotten worse. Infant mortality rates are also high. In New York State, the maternal mortality rate1 is 18.5 for every 100,000 live births, and the infant mortality rate2 is 4.3 for every 1,000 births. For two of the counties we serve, the infant mortality rates climb even higher—6.6 for Erie County in western New York and 5.7 for Onondaga County in central New York.
The situation is even worse for Black mothers, whose nationwide mortality rate is 3.5 times higher than that of white mothers due to systemic factors like implicit bias in our medical system, unequal access to preventive health care, and other social determinants of health. Moreover, a Black baby is twice as likely to die as a white baby in the U.S.
Whether at the national, state, or local level, these statistics are about to become even grimmer, especially for families with low incomes and from underrepresented groups. The main reason is the budget reconciliation bill H.R. 1 (the One Big Beautiful Bill Act), which calls for systemic funding withdrawals from crucial public safety net programs. Over the summer, Congress passed H.R.1, and on July 4, 2025, President Trump signed it into law.
“We were already in an infant and maternal health crisis before this administration,” explains Darcy Dreyer, Director of the Maternal and Infant Health Initiative for the March of Dimes’ New York and New Jersey chapter. “Too many women are dying in childbirth, and in the year following childbirth, for us to take away whatever supports they have currently.”
A Government Shutdown, Administrative Hurdles, and the Potential Loss of a Life-Saving Subsidy
On October 1, 2025, the federal government shut down after Congress failed to pass an appropriations bill for 2026. As a result, on November 1, federal payments for the Supplemental Nutrition Assistance Program (SNAP) were suspended. A prolonged shutdown sets the stage for deep and painful cuts, which will only increase once H.R.1 takes full effect.
H.R. 1 will substantially cut Medicaid and SNAP, placing more of the burden on individual states and enrollees. Effective January 1, 2027, both programs will expand work and reporting requirements, and the annual recertification process will change to at least twice a year. Although pregnant and postpartum mothers will largely be exempt from work requirements, they will still face a much greater administrative burden because of more frequent and more complex recertifications.
The Medicaid program is currently the largest single payer of maternity care in the U.S., covering over 40 percent of all births. The percentage is higher for births in rural areas and much higher for specific populations, namely births to Black and Hispanic mothers. Making it more difficult for pregnant individuals to enroll, recertify, and participate in Medicaid will have tragic consequences.
In addition to H.R.1, the Affordable Care Act’s enhanced premium tax credits (EPTCs)—a subsidy that has enabled millions to access affordable coverage—are set to expire at the end of the year. If Congress doesn’t extend EPTCs, millions of ACA enrollees could lose or drop their health care coverage—including new mothers. In fact, the majority of people enrolled in a subsidized ACA plan are women.
Here’s the collective impact of these recent federal cuts:
- A reduced federal investment in Medicaid by over $900 billion over the next decade will put a huge financial strain on individual states.
- Lower Medicaid reimbursements will drive up costs for hospitals and physicians, particularly in rural and low-income communities with a high number of Medicaid enrollees. Services will be reduced, and some clinics and OB/GYN providers might have to close.
- Although Medicaid coverage for pregnancy and postpartum care won’t be directly cut, states will likely need to scale back maternity care benefits to make up for reduced federal support.
- Because of H.R.1, severe new restrictions on health coverage for noncitizens will discourage pregnant immigrants with lawful status from seeking prenatal and perinatal care—putting both themselves and their babies at risk.
- SNAP cuts will decrease access to nutritious food for low-income families, and the health of mothers and babies will suffer.
- Access to screenings for medical conditions that threaten a healthy pregnancy, such as preeclampsia and alcohol abuse disorder, will be decreased. Poor prenatal care leads to an increased risk for medical complications and even death during childbirth and the postpartum period.
- More babies will likely be born underweight and susceptible to infections and certain lifelong medical conditions. A decrease in safety net support often is associated with an increase in preterm births (delivery before 37 weeks) and low birth weights (under 5 pounds)—already the two leading causes of infant mortality in the U.S.
- Racial and socioeconomic health disparities are expected to deepen, making pregnancy even more difficult for women of color and those with low incomes.
What the Future May Hold
Combating the maternal and infant health crisis in the U.S. requires innovative approaches. Unfortunately, targeted solutions like preconception checkups, doula services, postpartum home visits, and nonprofit initiatives will be lost in the shuffle as everyone copes with shrinking government funding.
Whether through Medicaid, SNAP, or ACA cuts, decreased access to care will put more lives at risk. “It’s going to be somebody that you know that’s going to have a tragic death that could have been prevented with access to care,” Dreyer says. “The state of maternal and infant health is an indicator of how well a country is doing to take care of its people.”
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- Maternal mortality refers to the death of a pregnant person from pregnancy-related causes within 42 days of the pregnancy ending.
- Infant mortality refers to the death of a child after birth and up to 12 months old.
