Let's begin with sentiments with which we all agree: The birth of healthy babies is important, and we as a society have a responsibility to support women during the birthing process.
But wait: What about medical care during a woman’s pregnancy? Surely the honor we accord pregnancy and the potential we see in newborn babies translate into a plan to ensure that women have health care during pregnancy.
That’s what I thought too. But then I read “Insuring Healthy Births,” a report prepared by the Maternity Care Coalition, a nonprofit organization committed to “strengthening families one baby at a time.”
The report starts with an obvious point: Lots of Pennsylvania women are uninsured, which makes it really hard for them to get medical care.
Pregnancy opens the door to Medicaid coverage for some women — those with incomes below 185 percent of the federal poverty level. But for women with higher incomes — say $34,000 or more annually for a family of three — pregnancy does not lead to expanded public coverage.
For these women, private health insurance has been the traditional source of help.
Increasingly, however, employers are dropping work-related coverage due to spiking rates and declining business profitability. That leaves the individual insurance market, which has always exacted a very high price from customers (such as pregnant women) who need medical care.
How many Pennsylvania women go through their pregnancies without health coverage of any kind?
Based on data provided by the Insurance Department’s “2008 Pennsylvania Health Insurance Survey” and the National Center for Health Statistics, about 16,600 uninsured women give birth annually. Medicaid provides coverage for nearly 10,000 of these mothers during their pregnancies; the other 6,600 are on their own to cobble together care from providers who agree to provide care despite the lack of insurance.
“To cover the costs of prenatal and post-partum care for women with no insurance, doctors, hospitals and clinics will often make private payment arrangements,” according to the Coalition’s report.
“Hospitals receiving funds for uncompensated care are required to have charity care policies, but these vary among hospitals. Alternatively, uninsured women may receive prenatal and post-partum care at safety-net institutions such as city-funded clinics, federally qualified health centers, rural health programs, or other ‘free clinics,’ which often have long waits for service.”
Doesn’t Pennsylvania have a backup plan to help women without coverage arrange the medical care they need? No, it doesn’t. Each woman is on her own to make it the best she can. There is no statewide plan.
Pennsylvania can and should do better. We can increase public coverage by using available federal dollars to expand the adult Basic Program. We can stem the decline in employment- based coverage by enacting rate protections that end annual rate spikes for small employers. We can fund community health clinics that provide obstetric care based on a woman’s ability to pay.
In the spirit of celebrating mothers, these modest steps are the least we can do.
Berry Friesen is the public affairs manager for the Pennsylvania Health Access Network, a statewide coalition committed to affordable health care for all.
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