Even as there has been tremendous outcry over the intractability of reducing the United States’ maternal mortality rate, they have remained stubbornly stagnant and have instead gotten worse with time. This current version of my Master’s paper research asks to what extent the crisis is driven by unique features of the American political economy and structure of the American healthcare system. I use a three-pronged approach: I first look at discrepancies between Black women’s uninsurance rate and their satisfaction with their medical coverage. I then look at OECD data on healthcare expenditure to show the exceptional features of how the United States allocates its healthcare funding. Finally, I look at the disconnect between federal and state mandates around maternal health care in comparison to local maternal care programs to show the patchwork nature of American healthcare. Taken together, I argue that much of the dramatically higher rates of maternal mortality and morbidity are driven by racism, yes, but the United States is unique in the world for the number of sites where birthing people are subject to state surveillance and prejudiced treatment. This means that while closing coverage gaps is important, it is an inadequate solution to durably and significantly reshape the risk that birthing people, Black women in particular, have to contend with during what is an incredibly vulnerable time.