LINCOLN Charities, hospitals and other nonprofit groups are scrambling to fill the void left by the state's decision to end state Medicaid funding for prenatal services for low-income women, including many illegal immigrants.
In nearly two dozen interviews, Nebraska providers said that while they may be able to absorb the costs for women now pregnant, the long-term outlook for providing an estimated $10 million a year in health care services without reimbursement is bleak.
Hospitals are bracing to provide more “charity care” and expecting an increase in emergency-room visits from women who experience pregnancy complications due to the lack of prenatal care.
A couple of emergency fundraising events have been scheduled, and private donors and the United Way are being asked to dig deeper.
Clinics that focus on the poor and uninsured are shifting resources away from other areas, such as mental health and diabetes care, to cover the loss of funds for services that can head off expensive birth defects and premature births.
“We only have so many resources. If we start pouring more money into uninsured pregnant women, that will take away from what health care we can offer in other areas,” said Dr. Kristine McVea, medical director at the OneWorld Community Health Center in south Omaha.
The issue of whether hospitals, health clinics that focus on the uninsured and private physicians can shoulder the load for such low-income women without government help is now front-and-center in the controversy.
The debate intensified last week after a Schuyler, Neb., doctor said one of his patients opted to have an abortion because she couldn't afford the cost of prenatal care on her own. At least seven other women in Omaha and Schuyler have told clinicians they plan to seek abortions.
Gov. Dave Heineman, who opposes government aid for illegal immigrants, has said he expects charities, church groups and others to pick up what the government cut off.
Last week, Heineman was asked directly if he knew of any charities that would do that. He didn't.
“That remains to be seen,” Heineman said. “All I can say is that Nebraskans and Americans generally have always been generous in this regard. I would hope that they would step up to the plate.”
Heineman has declined to resume state funding for the women's prenatal care, as he could have administratively, and opposed attempts by the Legislature to do so. That sparked a battle pitting the state's abortion opponents and medical groups and Catholic bishops against Heineman, an abortion opponent, and others who oppose illegal immigration.
Officials with several hospitals and clinics, including Methodist Health System, Alegent and Creighton Medical Associates, said women will continue to have access to existing discounted care, often based on income.
“We are not going to deny them care,” said Calvin Hiner, administrator of Tri-County Hospital in Lexington, which has a large immigrant population.
Joan Neuhaus, chief operating officer for Alegent Health, which delivers the most babies in Nebraska, estimated that her institution alone would be picking up $2 million in additional costs.
As of March 1, there were 1,619 low-income women who lost prenatal services because of a federal directive that ended the more than 20-year practice in Nebraska of providing such care regardless of the women's immigration status.
About 4,700 low-income women were able to retain prenatal care after a state review.
Of the 1,619 who lost coverage, 752 were U.S. citizens deemed ineligible for reasons such as not following the rules in other welfare programs or not disclosing their incomes or other information. The rest were 867 illegal immigrants.
An estimated 2,800 women would lose services over the course of the next year with the loss of the funding.
The state's March 1 order cut off many women midway through their pregnancies, creating a dilemma on how they will obtain ultrasounds, blood tests and other prenatal services.
Such services can cost as much as $1,500 to $2,000, doctors say. The state's Medicaid program reimburses for only about half the cost, an estimated $775.
The Medicaid cutoff leaves physicians in the position of absorbing the entire cost of such care. Those interviewed said the number of doctors who will see patients who cannot pay any costs is few.
“As it is, we write off so much bad debt and send patients to the creditors when we have to,” said Dr. Suzanne Vandenhul, a Lincoln family physician.
She expressed frustration with Heineman and state lawmakers, adding that there are few other places to refer pregnant women.
The state does have five federally qualified health centers that offer prenatal services. They charge as little as $350 to $500 for a prenatal package if a woman's income is low enough.
Those clinics in Gering, Columbus and Lincoln and two in Omaha already are reporting caseload increases.
Andrea Skolkin, chief executive officer of the OneWorld clinic, said the government aid cutoff has put her staff and all who treat pregnant women in a “very uncomfortable position.”
They know that prenatal care can save lives and avoid birth defects and other health risks, but now they're looking at picking up the entire cost. Her clinic got about $500,000 from Medicaid last year for prenatal care.
“We hope that the philanthropic community can come out and help,” Skolkin said. “We don't want any women to go without prenatal care. No woman should have to go through that agony, especially when you have a new life inside of you.”
The United Way chapter in Columbus said an additional $10,000 might be available for prenatal care, but that would cover only a fraction of the Good Neighbor center's annual $320,000 to $370,000 cost of prenatal services, said Rebecca Rayman, executive director of the health center.
“Our people are mission-oriented, but they can't work for nothing,” she said.
The Good Neighbor center is cutting psychiatric services, utilizing more nurses to help their ob/gyn doctors and planning to see 10 women every half-hour instead of the normal two or three.
“We have three times more women to see, and we're going to try and see them in the same amount of provider time. That's tough,” Rayman said. “This is not a long-term fix, it's a Band-Aid.”
In the Grand Island area, Teresa Anderson of the Central District Health Department estimates that 72 pregnant women a year in her three-county district will be seeking care that would cost about $288,000.
“I sense a willingness (of charities) to step up to the plate,” Anderson said. “But I do not believe they have the capacity to meet the needs of the women who lost Medicaid.”
State Sen. Jeremy Nordquist of Omaha, who wants to restore government aid for prenatal services, said it doesn't make sense to force charities to pick up the entire cost of these services.
Nordquist said resuming them through state government would glean a 70 percent reimbursement from the federal government.
“How many times can we call on charity to do things?” he asked. “There's only so much charity out there.”
Contact the writer:
402-473-9584, paul.hammel@owh.com
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