The Philadelphia Inquirer, May 4, 2006

Pregnant and Uninsured
By Gene Bishop, a Philadelphia physician

Let's play the old word association game.

Think "childbirth" - joy, labor pain, motherhood.

Think "insurance" - boring, deductibles, co-pays.

     Think "uninsured" - your neighbor who lost her job, your child who just graduated from college, the cashier at the convenience store who works when her kids are in school.

     What you might not think about are the one in five women in the United States who did not have health insurance 12 months before they had a baby.

In Chester County, more than three-fourths of pregnant women eligible for a federal program to help them did not have health insurance when they entered the program. More than half of the Latina women in Chester County between 18 and 45 have no health insurance. Across the state, twice as many African Americans are uninsured as whites.

     The largest population group in our state that lacks health insurance is also the group most likely to become pregnant. Forty-nine percent of uninsured Pennsylvanians are between 18 and 34 years old. Even more frightening, 68 percent of uninsured children in our state are between 11 and 18. Those are the very years when we are trying to reach adolescents with information about caring for themselves - what it means to consume a healthy diet, avoid cigarettes, seek meaningful and safe sexual relationships, avoid unintended pregnancy, and seek preventive health care.

    What does it mean to be pregnant and uninsured? The uninsured pregnant woman is less likely to have had a Pap smear, less likely to know if she has undiagnosed diabetes or high blood pressure. She's less likely to be taking folic acid, a simple vitamin that when taken before conception and during very early pregnancy prevents spinal-cord birth defects. And she's much less likely to obtain early prenatal care.

     Ironically, once pregnant, many low-income women suddenly have much better access to health insurance. As long as their incomes are below 185 percent of the federal poverty level, they are immediately eligible for Medicaid. Pennsylvania has made excellent efforts recently to make it as easy as possible for pregnant women to obtain insurance immediately. Some women report leaving their part-time jobs to become Medicaid eligible.

     However, many working women earn more than the Medicaid limit. They must pay out of pocket for maternity care and delivery. These are high costs. Once you're pregnant, you can't buy health insurance to cover yourself. Some plans don't even cover pregnancy. High-deductible plans typically marketed to consumers between ages 20 and 35 either do not include maternity benefits or include very high deductibles and co-insurance - $2,000 plus 20 percent of the hospital bill after the deductible.

     What happens to uninsured pregnant women in our region? An increasingly stressed safety net system struggles to provide care to all who need it. This system includes city health centers in Philadelphia, and federally qualified health centers and teaching hospitals in the region. Outside of Philadelphia, in particular, the number of practitioners accepting Medicaid has dropped, and even fewer sites will see the uninsured.

     In August, the Maternity Care Coalition searched the Web site of one Medicaid HMO and found 69 ob-gyn providers listed within a five-mile radius of Norristown. But those 69 were all within 10 different practices, and only four were still in existence and accepting new patients.

     Even as public health officials and doctors encourage women to obtain early prenatal care, many women are well into their second trimester by the time they find a practitioner and are given an appointment.

     These days, not a week goes by without a media feature on our national shame: the failure to guarantee health care to our residents via national health insurance. But an even bigger shame is our failure to adequately insure women of childbearing age.

Back to the word game. Uninsured? Think dangerous to your health.

Gene Bishop (sprucedoc@verizon.net) has done consulting work for the Maternity Care Coalition.

Learn about the childbirth crisis through our Maternity Care in Southeastern PA pages, or visit our Maternity Services Advocacy pages to find out how communities are advocating and how you can take action!

MCC's full Childbirth at a Crossroads report can be viewed here.