Abstract
[INTRODUCTION] On a hot Fourth of July in 2021, Harmony Ball-Stribling spent her final day laughing with her husband, hours before preeclampsia killed her. Harmony was eight months pregnant and living in Belzoni, Mississippi, where she celebrated the holiday with her church congregation. Her congregation prayed over her and her baby for a safe delivery, as she was scheduled to have a cesarean section in five days.
Later that evening, Harmony woke in agony, vomited, and complained of chest pain to her husband, Mr. Stribling. Harmony’s husband put his wifein their car and began the more than thirty-mile drive to the nearest hospital. On the way there, Harmony suffered a seizure, and Mr. Stribling could not revive her. Harmony’s death certificate labels her death as a medical complication of preeclampsia.
Preeclampsia is a complication of pregnancy that produces symptoms of high blood pressure, decreased levels of platelets in the blood, severe headaches, nausea or vomiting, shortness of breath caused by fluid in the lungs, and other symptoms. Doctors recommend screening for preeclampsia when there are risk factors present—a noted risk factor is “African American race.”
Shortly before the tragic passing of Harmony, Shalon Irving, an epidemiologist working for the Centers for Disease Control and Prevention (“CDC”), also became a victim of maternal mortality. Irving, a Black woman, died after suffering a cardiac arrest in her home—only three weeks after giving birth. Irving had just been to her doctor, where she expressed concerns about her health, which were dismissed. Irving was a well-educated woman who had access to health care services in her town, yet she still became a casualty of racial disparities in maternal health.
Harmony Ball-Stribling and Shalon Irving are among the rising number of Black women in the United States who are losing their lives during pregnancy and postpartum. In 2023, Black women had a mortality rate of 50.3 deaths per 100,000 live births, which is more than three times the death rate for white, Hispanic, and Asian women combined.
This Comment argues that the current language of Section 1557 of the Affordable Care Act (“ACA”) violates the Equal Protection (“EP”) rights of Black women who are pregnant and postpartum, and contends that the Ninth Circuit has correctly interpreted this provision. Part II provides background statistics on maternal mortality in the United States. Part II also introduces Frontiero v. Richardson, which established that a new or quasi-suspect class may be recognized when a group has suffered a history of discrimination, is defined by an immutable characteristic, lacks political power, and the classification bears no relation to the group’s ability to contribute to society. Part II lastly demonstrates how the Ninth and Fifth Circuits’ interpretations of Section 1557 cases are at odds with each other. Part III argues that pregnant and postpartum people deserve to be a quasi-suspect class warranting intermediate scrutiny. Part III then compares the Ninth and Fifth Circuits’ jurisprudence to demonstrate that the Ninth Circuit applied the correct level of scrutiny in its analyses. Part IV recommends that Congress and the Department of Health and Human Services (“HHS”) collaborate to revise the language of Section 1557. Part V concludes by reiterating that the Ninth Circuit’s language and understanding of Section 1557 is correct and should be referenced in the rephrasing of Section 1557.
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