Prenatal care debate: Beyond costs

LINCOLN — The 30-year-old woman who walked into south Omaha's OneWorld Community Health Center was scared.

She was 16 weeks pregnant and needed a $50 test to determine if she suffered from a dangerous but treatable prenatal condition.

But she didn't have the money and didn't know where to get it.

OneWorld gave her the test anyway, and she was found to have gestational diabetes.

However, the health center for low-income people cannot afford to pick up the $300 cost of what it recommends for such women: a course at the University of Nebraska Medical Center that teaches how to use a glucose monitor and how to manage the diabetes through low-sugar diets, exercise and, sometimes, medication.

The OneWorld patient was among 1,550 women, as of March 1, who lost their state Medicaid coverage for prenatal care because of a directive from the federal government. More than half — 842 — were illegal immigrants.

Medicaid formerly paid about $775 for prenatal care per woman.

Whether the woman with gestational diabetes is an illegal immigrant is unknown. OneWorld, whose clients are mostly Hispanic, doesn't ask about immigration status. Dr. Kristine McVea, chief medical officer of the center, described the woman's health situation without naming her.

McVea, along with the state's medical groups and organizations that oppose abortion, falls on one side of the debate on whether to restore prenatal services to these women. McVea says the compassionate and cost-effective thing to do is to restore such care to women, even those here illegally.

“That someone would think so strongly about immigration that it would supersede the health of a baby …” said McVea, her voice trailing off. “Yes, illegal immigration is an important issue, but babies dying is an even more important issue.”

On the other side are Gov. Dave Heineman and groups opposed to illegal immigration. They say that prenatal care is important, but the real issue is providing taxpayer-funded services to people here illegally.

“I'm willing to acknowledge that both issues are compelling, but the other side wants to ignore that these people are in the country illegally,” Heineman, an abortion opponent, said recently. “People who are working hard, who are struggling, do not want their taxes going to benefit illegal individuals.”

Heineman and others say church organizations and other private groups will step in and help those who have lost Medicaid coverage.

“It's not a meanness issue, it's a policy issue,” he said.

Said McVea: “I don't think the governor has a good understanding of health care. If he thinks charity care can take care of this, no. The sad reality is, we don't have the resources.”

So far, health clinics that serve low-income people without insurance say they are seeing an increase of pregnant women who have lost state prenatal coverage.

At the Good Neighbor Community Health Clinic in Columbus, 41 pregnant mothers came in for help during the week before March 1 and the week after. Normally the clinic gets three pregnant women in an average week.

Some of the women came from as far away as Lexington, Hastings and Grand Island because there are no health clinics or private obstetrics-gynecology physicians in their area who will take women who can't pay for services.

“Every clinic in the state is concerned,” said Rebecca Rayman, executive director of the East-Central District Health Department, which runs the Columbus clinic, one of five federally approved clinics in the state that offer prenatal services.

“There are not a lot of local providers who can see people for free,” Rayman said.

The Columbus clinic, which requires a small co-payment, has not turned any women away. But 70 percent of its funding comes from patient payments.

Rayman said a recent fund-raising appeal to “adopt” a pregnant woman's prenatal expenses elicited only three “adoptions.”

Health professionals like McVea and Rayman offer numerous reasons why spending money on prenatal care could head off more expensive taxpayer-funded health care expenses after the children are born. They include:

Children of parents here illegally automatically become citizens upon birth in the U.S., making them eligible for Medicaid beginning with delivery room costs.

For every $1 spent on prenatal care, $3.33 is saved on post-delivery care and $4.63 in long-term care costs, according to the American Congress of Obstetricians and Gynecologists.

Premature, low-weight babies — more likely when women don't get prenatal care — stay an average of 12.9 days in the hospital, compared to two days for a healthy birth. That raises average costs to $15,100 from about $600, according to the March of Dimes.

The risk of a woman having a premature baby is normally about 10 to 12 percent; without prenatal care, the risk can be as high as 50 percent, said Dr. Caron Gray of the Creighton University Women's Health Center.

A study published in 2008 in the American Board of Family Medicine estimated that, among teenage mothers on Medicaid, prenatal care saved between $2,369 and $3,242 per person.

The state would save an estimated $3.7 million over the next 15 months by not resuming prenatal coverage for illegal immigrants and the nonimmigrants who now fall below the income qualification levels.

Rayman, of the Columbus clinic, said those savings would be wiped out by just a couple of complicated cases that are due to the lack of prenatal care.

McVea said in the case of the woman with gestational diabetes, low-tech steps can head off the potentially “disastrous” consequences of not treating the condition immediately.

Without treatment in such cases, there is increased risk of birth defects, premature births, miscarriages and a condition in which babies grow too large. It's called “macrosomia” and it increases the chances of expensive cesarean section deliveries.

McVea said her clinic is trying to “cobble together” an alternative education course for the woman, but it doesn't have the resources to keep doing that.

“There's certain things we can't afford either,” she said. “We're really struggling about what to do about these women and what other services do we have to cut.”

Contact the writer:

402-473-9584, paul.hammel@owh.com

« Metro/Region

Share