State Rep. Alex Andrade (R-Pensacola) seeks to tackle one of the state’s most troubling healthcare disparities: infant mortality rates that disproportionately affect Black families. In a recent episode of the “Don’t Color on the Dog” podcast, Andrade revealed his plan to reshape how Florida’s Medicaid program addresses maternal and infant health.
Background: In Escambia County alone, the infant mortality rate for Black babies stands at over 13 per thousand births. The ratio between Black and white infant mortality is three to one.
- “The racial disparity alone is jarring, right? When I realized just how significant the racial disparity on this alone was, my jaw dropped,” said Andrade.
Infant Mortality – Deep Dive
What makes this crisis even more urgent is that it’s largely preventable. Andrade has used his position as chair of the House Health Care Budget Subcommittee to gather the latest data on the problem.
“Rick, thanks to your coverage, I did a deep dive on this stuff and realized that 25% of infant mortality deaths are due to unsafe sleeping conditions,” Andrade said. “And something like 45% are due to issues that are potentially preventable in the first trimester—such as preterm births, hypertension, getting pregnant immediately after giving birth, not having any type of care in that first trimester, not taking prenatal vitamins.”
- The lawmaker added, “Those types of things, along with unsafe sleeping conditions, account for almost 70% of all infant mortality. And when you look at that and you see at least on paper how significantly high the rate of preventable infant deaths are, you can’t look at that and not try to do something.”
Medicaid Overhaul: Incentivize Outcomes
Andrade believes that the Agency for Health Care Administration (AHCA) can help reduce infant mortality statewide by focusing on outcomes.
- Fact: Medicaid covers over 40% of expectant mothers statewide. In Escambia County, that number jumps to 68% for Black mothers and 30% for white mothers. Andrade explaiAndrade explained.
But Andrade isn’t just identifying problems—he’s proposing solutions. As chair of the Health Care Budget Subcommittee, he’s calling for a fundamental shift in how Florida manages its Medicaid contracts with major insurance companies like Aetna and CVS.
- “We have to start looking at our approach as the state…and figure out how we can do less micromanaging, and instead really internalize the fact that all we care about are the healthcare outcomes,” Andrade said.
He argues that Florida has focused too heavily on measuring activities rather than results. “If ultimately all we care about are you turn in financial reporting forms for these Fortune 5, Fortune 50 companies, and we don’t care about whether or not they’re actually incentivized to improve healthcare for the people on Medicaid, I think we’ve lost the plot.”
Solution
His proposed approach would set clear, outcome-based goals for the insurance companies managing Medicaid contracts. “We want you to reduce these rates of infant mortality by X in a given year and in your region, in your population, in the counties you cover,” Andrade explained, adding that proper incentives could leverage these companies’ sophisticated healthcare management capabilities…