Midlands Voices: Nebraska funding for prenatal care will save money in long run

Rodgers is chairman of the Douglas County Board of Health. Dr. Filipi is a board member.

The Douglas County Board of Health joins the Nebraska Medical Association, the Nebraska Hospital Association and other groups in support of Legislative Bill 1110, a bill which would increase state funding of prenatal care for low-income women.

In Douglas County, a community collaborative called Baby Blossoms — made up of 35 local agencies including health care systems and human service agencies, under the leadership of the Douglas County Health Department — works to reduce infant mortality by making systematic changes aimed at improving birth outcomes.

For the past three years, this collaborative has studied the contributing factors related to fetal and infant death. Inadequate or no prenatal care consistently ranks as one of the top 10 themes identified among those women who experienced loss. The Baby Blossoms Collaborative has therefore recognized prenatal care as one of its primary areas for improvement.

Through focus groups with women, it was learned that women believe prenatal care is important and that they should attend all of their visits, even when they are not experiencing problems. However, one of the primary factors in women delaying or not accessing care is their inability to pay for care.

For more than 15 years, the State of Nebraska has paid for the prenatal health care of many low-income pregnant women. The state did so regardless of immigration status largely because the baby born of that pregnancy is an American citizen by federal law. Medical science shows that with prenatal care, babies are healthier and it decreases society’s health care costs.

In May 2009, the Centers for Medicare and Medicaid Services (CMS) informed state Medicaid directors of a new option for states to provide State Children’s Health Insurance Program (SCHIP) coverage to targeted low-income pregnant women. In September 2009, states were told that they could include in SCHIP plans the pregnancy-related care for the unborn child, regardless of eligibility status.

Waiting until Jan. 15, 2010, Nebraska’s director of Medicaid sent a letter to all state senators stating that some pregnant women would lose coverage for prenatal care unless coverage was provided “through the adoption of a program funded solely with state dollars.”

This letter was sent at the deadline for introducing any new bill. It did not offer the reasonable alternative that a new program under SCHIP would be eligible for federal funding and help solve the problem.

Even now, undocumented pregnant women will continue to be covered by Medicaid when they go into labor. At this point, they become “emergency services” with payment mandated by federal law. Therefore, only payment for prenatal care is denied as a result of the program change. This makes no sense.

Under the current Nebraska Medicaid fee schedule, the cost of the state paying the physician for the necessary laboratory and imaging tests totals under $800. According to a 2008 study, the average direct health care costs increase by at least $2,300 during only the first year of life of a baby whose mother did not receive prenatal care.

Of course, for a low birth-weight infant — an occurence decreased by prenatal care — that hospitalization could cost more than $1 million, paid by Medicaid, our tax dollars.

So, spending $800 for prenatal care will save at least $2,300 during the first year of the infant’s life. In addition, the baby is less likely to suffer from ongoing health problems such as cerebral palsy and congenital heart disease.

There’s a solution. State Sen. Kathy Campbell successfully introduced LB 1110 to ensure that these critical services are provided under SCHIP.

To protect our scarce public health care dollars and foster healthier children born in Nebraska, we must advocate strongly for passage of LB 1110. It’s the right thing to do for reasons of health, finance and basic morality.

This Midlands Voices essay reflects the views of the writers and not necessarily the editorial position of The World-Herald.

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