January 6, 2026
Charlene Muhammad |
California Black Media
Gnae Dismuke experienced a miscarriage at 11 weeks in 2017 and later gave birth to three children, now ages six, four, and one month.
Dismuke says she’s encouraged that programs exist to advocate for safer birth outcomes for Black women like her. However, when it comes to actual practices of medical facilities and doctors, she has a conflicted perspective – a point of view shaped by her three birth experiences: one in a hospital, one at home, and another in a hospital.
Dismuke, who lives in Los Angeles, addressed her birthing challenges with the help of Black Infant Health in partnership with the Long Beach Public Health and Human Services Department. They supplied doulas and nurses who visited her home during her last birth and advocated on her behalf.
“The nurse was able to move mountains quickly that I wasn’t able to move with the medical industry, with just advocating for me, asking for things like physical therapy,” she stated. Statistics show that Black women in California are three to four times more likely than White women to die from pregnancy-related complications. Some birth equity advocates argue that expanding access to midwifery care and certified birth doulas could help reduce these disparities. Others emphasize the need for education, noting barriers such as high costs for preferred birthing options and managing high-risk factors like hypertension and stress related to systemic discrimination.
“Doctors don’t want to see you until almost the end of the first trimester. That’s 11 to 12 weeks in. Many things could go wrong,” Dismuke said, recalling experiencing spontaneous bleeding in the first trimester for all three of her births. “Groups like M.O.R.E. Mothers, a nonprofit maternal health-focused community-based organization in Long Beach, are part of programmatic solutions. They provide classes and workshops,” she added.
To assist mothers like Dismuke, the Department of Health Care Services (DHCS) added doula services to preventive services covered under Medi-Cal in 2023. Still, many mothers don’t know these benefits exist because Medi-Cal coverage is based on income, but those pregnant qualify at higher income levels than other adults.
“I thought [a doula] was for people who had money, who had private health insurance and stuff like that,” said a Medi-Cal beneficiary who asked not to be identified.
Under Assembly Bill (AB) 133, doula services were formally included as a “covered preventive service” under Medi-Cal in 2023. AB 133 was co-authored by former State Sen. Nancy Skinner (D-Berkeley) and Sen. Akilah Weber (D-San Diego), a pediatrician. It built on the California “Momnibus” Act, passed in 2021, aimed at improving maternal and infant health outcomes among Medi-Cal members.
“Access to doula services means that any time in their trimesters, they can have eight sessions with their doula, whether virtual, Telehealth or in-person. The doulas are with them through their labor and delivery, and can help clients, partners, families, be prepared with a birth plan, education, and understanding labor stages,” said Los Angeles-based Sister Marquita of A Sister By Your Side doula services.
Doulas also help mothers understand their rights during labor and delivery, and Medi-Cal support extends postpartum care until the baby reaches one year of age.
The statistics are personal for Jade Ross, a member of Los Angeles County MotherBoard, an advisory collaborative of Black mothers working at the intersection of healing, advocacy, and sustainable systems change to create a more just and equitable world for Black mothers and babies.
“That’s why I do the work I do: so Black women can basically birth in joy without trauma,” stated Ross, while cuddling her 11-week-old infant, Kalea.
“A lot of it has to do with education,” continued Ross, speaking at the 2025 California Black Birth Equity Summit in Sacramento. “I think a lot of people have certain ideas about what midwifery or holistic care looks like, or, on the other end, don’t trust the medical system.”
Held biannually, the Summit was founded by Mashariki Kudumu, a doula and public health advocate. This year, it was co-hosted by the California Coalition for Black Birth Justice and UCSF Center for Birth Justice. Themed “Rooted in Action,” the Summit brought over 500 clinicians, midwives, doulas, and policymakers together. Sonya Young Aadam, CEO of the California Black Women’s Health Project, said, “I strongly believe that our advocacy in these spaces can make a difference. We go in and we demand the care that we need. But many of us are not even aware the disparities exist.” Despite progress, disparities persist.
According to the 2025 State of Black Birth Equity in California Report, the state continues to experience disproportionately poor outcomes, even with low maternal mortality and strong infant health outcomes.
Jennie Joseph, a B2025 expiration date.
Open enrollment for Covered California continues through Dec. 31 for coverage that begins Jan. 1. For coverage starting on Feb. 1, enrollment is available through Jan. 31, so there remains time for people to sign up, Altman said.
“There’s not really another explanation for (enrollment) being lower than normal in other years other than the enhanced premium tax credit expiration,” Altman said. “That could be people who are waiting and watching and hoping the prices change, and planning to come in but haven’t made the decision yet.”
About 2 million California residents purchase health insurance through Covered California. The vast majority of those are people whose employers don’t provide health coverage to employees, self-employed business owners, freelance “gig economy” workers, and people who make too much money to qualify for Medi-Cal, the state’s incarnation of the federal Medicaid program for low-income residents.
As of July 2025, about 202,000 residents in the San Joaquin Valley, from San Joaquin County in the north to Kern County in the south, were enrolled in Covered California. More than 90% have at least part of their costs for premiums subsidized by tax credits.
Earlier this year, Covered California projected that its subsidized enrollees in Valley counties would experience large increases to their monthly health insurance premiums if the enhanced tax credits expired:
Fresno County: Average increase of 160%.
Kern County: Average increase of 160%.
Kings County: Average increase of 147%.
Madera County: Average increase of 139%.
Merced County: Average increase of 388%.
San Joaquin County: Average increase of 129%.
Stanislaus County: Average increase of 112%.
Tulare County: Average increase of 140%.
Despite the expiration of the enhanced credits, lower-income Covered California members would continue to benefit from the standard level of Affordable Care Act credits.
While new enrollments are down so far, the effects of higher rates and reduced subsidies for renewing Covered California enrollees are still unclear. Altman said that’s because people have more options open to them besides either renewing or going without coverage.
Many of the insurance providers that sell coverage through Covered California offer different tiers of insurance plans with different monthly premiums, different levels of coverage, and different deductibles for covered services.
“Renewals are looking stable right now,” Altman told CVJC. “We’re seeing some people come and actively shop, maybe change their plan, or say, ‘No, I really still want the one that I had.”
“The most common version of that is someone who is choosing a plan that has a lower premium but a higher deductible, higher cost sharing,” she said. “There are trade-offs there.”
“The silver lining is that a person who at least right now is saying, ‘My intent is to maintain health insurance (but) I feel like I have to choose a health insurance plan that has a lower cost,” Altman added.
But there is concern that the ongoing political controversy in Congress over the expiration of the tax credits is causing people to sit on the sidelines and take no action to enroll or renew.
The expiration of the tax credits was a key sticking point in the logjam between Republicans – who have narrow majorities in both the House of Representatives and the Senate – and Democrats who stand to gain ground in the 2026 midterms.
That failure to compromise led to a shutdown of the federal government from October into November. The shutdown ended without any agreement on extending the tax credits, save for the promise of a future vote on an extension.
“The consumer awareness of what is happening, and why, is higher than I would have thought,” Altman said. “This is the first time there’s been such confusion in the midst of open enrollment when people are actually tuning in and having a decision to make.”
An extension of the tax credits is not the only proposal being bandied about in Washington. President Trump and some Republicans in Congress have instead called for providing money directly to consumers rather than tax credits through the Affordable Care Act.
Whether those alternative proposals would provide the same financial benefit to consumers, or what kind of restrictions would be imposed on how the money is spent by consumers, remains to be seen.
“Unfortunately, if there’s any certainty right now, it’s that there’s no guarantee that Congress is going to get anything across the finish line” before the drop-dead enrollment deadline of Jan. 31 for Affordable Care Act coverage that would begin on Feb. 1, Altman said.
But she added that if Congress does manage to extend the expiring tax credits without any structural changes, Covered California would be able to quickly reopen its enrollment for people to realize the savings from the subsidy.
If, however, there are substantial changes to the tax credit program, or different ways of providing some level of direct financial relief to consumers, it could take considerably longer for that to be passed along to enrollees. “We will figure it out, but it could take a lot more time,…” Altman said. “It’s not easy to put the toothpaste back in the tube, as one would say.”rit
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