'State of health care for women is in a fragile place'—Florida women are dying from preventable causes

Florida women are dying from causes that are preventable, including breast and cervical cancer, pregnancy complications and mental health conditions, according to a new national scorecard of women's health.

The scorecard issued by The Commonwealth Fund assessed women's health and reproductive care in the United States over the last two years to measure the consequences of state policy choices and judicial decisions that limit women's access to health services and reproductive care.

The 2024 Scorecard on Women's Health and Reproductive Care comes amid a March 2024 National Center for Health Statistics finding that women's life expectancy is at its lowest since 2006.

Using 32 measures, The Commonwealth Fund, a private health care research foundation, ranks Florida in the bottom third of the country (39th) for how well the state's health care system works for women ages 15 to 44. Overall, Florida has a higher than the U.S. average rate of women who lack insurance, die while pregnant, give birth without prenatal care, and succumb to breast and cervical cancer.

"Our hope is that state policymakers can use this scorecard to identify and address gaps in care to guarantee that all women across the United States can live healthy lives with access to quality, affordable care, no matter where they live or what their background is," said Joseph Betancourt, Commonwealth Fund president.

One of the biggest concerns highlighted in Florida's low ranking is its high rate of uninsured women ages 19–64. It is one of 10 states that have not expanded eligibility for Medicaid and has had a problematic unwinding of pandemic-era Medicaid coverage that has left thousands of women either newly uninsured or with significant gaps in their coverage.

Women in states like Florida that have not expanded Medicaid eligibility report skipping health care at higher rates than in states with expanded eligibility. The scorecard shows 22% of women ages 18–44 reported a time in the past 12 months when they needed to see a doctor but could not because of cost.

"One out of six women in Florida lacks health insurance," said David Radley, senior scientist, Tracking Health System Performance, The Commonwealth Fund. He notes the state also has a high percentage of women who don't have a primary care doctor. A regular provider can help manage chronic medical conditions, conduct screenings and test for diseases.

"To me, the takeaway is if you can get access into the health care delivery system in Florida, you can probably get pretty good care. But if you can't get access, you are going to feel it in your health and life expectancy. If you don't have that doctor to go to who understands your circumstances, you are not as likely to get the things you need to help you live a long life," Radley said.

Overall, the scorecard's findings raise concerns over the ripple effects of the Supreme Court's 2022 decision to overturn Roe v. Wade and the access to reproductive health care services. A recent South Florida Sun Sentinel series, Born to Die, found expecting mothers in Florida, particularly those without insurance, are foregoing prenatal care leading to high rates of infant deaths and premature births.

Highlights from the Scorecard include various health trends that affect women's care in Florida:

• States like Florida with abortion restrictions tend to have fewer maternity care providers. Several dozen hospitals in Florida already have closed their labor and delivery units.
• Women of reproductive age in states like Florida that had not expanded Medicaid eligibility were most at risk of going without coverage, as well as skipping needed care because of cost.
• Nearly all states have witnessed an upward trend in syphilis among women of reproductive age since 2019. Florida's rate is higher than the national average.
• Rates of maternal deaths are highest in the Mississippi Delta region, which includes Arkansas, Louisiana, Mississippi, and Tennessee. All four states had abortion restrictions prior to the Supreme Court overturning the constitutional right to an abortion, and they all now have full abortion bans. Florida's strict six-week abortion ban went into effect on May 1. It is too early to measure how it could affect rates of maternal death.
• Deaths among women ages 15 to 44 were highest in southeastern states (which includes Florida). Top causes of death included preventable factors such as pregnancy complications, substance use, COVID-19, and breast or cervical cancer. Death rates from all causes per 100,000 women of reproductive age ranged from 70.5 in Hawaii to 203.6 in West Virginia. Florida's death rate is 114.

"Overall, there are mounting disparities in women's health and reproductive care across the United States," Radley said.

"Some states have built the policies up in ways to enable access to health care and some haven't. Florida is a state that has a large low-income population and a lot of people with no health insurance. And, they are less likely to get the care they want or need going forward. What we are finding is the state of health care for women is in a fragile place."

2024 South Florida Sun Sentinel. Distributed by Tribune Content Agency, LLC.