Progressive Voices

Plan to deny women prenatal care deals double blow to reproductive health care

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Cuts in maternity care trigger cuts in family planning

The North Carolina Senate’s move to deny pregnant women Medicaid coverage for prenatal care betrays a shocking lack of compassion. It also shows a willful ignorance of the tremendous strides our state has made in improving healthy birth outcomes for moms and infants.

Moreover, the move suggests our legislators care more about fast-tracking their political agenda than thinking through the unintended consequences of denying thousands of North Carolinians health care.

One such consequence is that reducing Medicaid eligibility for pregnant women will automatically lower the income eligibility for our state’s successful Be Smart Family Planning program that provides no-cost birth control, STD testing and life-saving cancer screening to tens of thousands of women and men in our state every year.

North Carolina is in the process of revamping the Be Smart Family Planning Program so that more individuals can obtain essential family planning services. But if the Senate’s provision goes through, it could thwart those efforts and restrict eligibility for Be Smart.

This is because eligibility under the newly designed family planning program cannot be higher than income eligibility for pregnant women—the Senate’s lowering income eligibility for pregnant women, in turn, lowers the income eligibility for the family planning program.

Both reductions in care significantly threaten the gains our state has made in public health over the last two decades, particularly for low-income women and their families.

In 1989 North Carolina had the highest infant mortality rate in the country. Expanding Medicaid eligibility for pregnant women from the lowest standard of 133% of federal poverty level to 185% demonstrably decreased infant mortality while saving the state untold thousands in neonatal intensive care costs associated with premature births.

Currently, low-income pregnant women are able to apply for Medicaid at their first prenatal visit in public health centers across the state. Early and easy access to prenatal care has made a difference in healthy birth outcomes.

In contrast, the Senate’s special provision would require thousands of pregnant women, who are currently uninsured and likely to have little experience in navigating the private insurance market alone, to enroll and pay for private insurance if the state’s limited subsidy does not cover the full cost. Only after securing health insurance would the pregnant woman find a prenatal provider–a completely avoidable and unnecessary delay.

Erecting obstacles to early and accessible prenatal care is a barrier our state left behind years ago. The same is true for access to family planning services.

North Carolina’s Be Smart program has extended preventive health care to more than 90,000 North Carolinians since it started in 2005. For the women participating this means access to basic health—an annual exam, life-saving cancer screenings including Pap tests and clinical breast exams, STD screenings and birth control.

The benefits of family planning are not limited to the patients served. Every dollar invested in family planning saves taxpayers nearly $4.00. A requirement of North Carolina’s Be Smart Family Planning Program is budget neutrality, meaning it costs the state no more money to run it than it saves.

In fact, the most recent report estimates that providing low-income women and men access to no-cost birth control, life-saving cancer screenings and STD treatment saved the state roughly $25 million in Medicaid costs alone.

Access to family planning services also means healthier birth outcomes for moms and infants down the road. Healthy women make for healthier babies. Spacing pregnancies so that a woman’s body fully recovers and is ready to develop a healthy baby is critical to healthy pregnancies and the prevention of pre-term births.

Denying pregnant women Medicaid coverage for prenatal care is blatantly cruel. Denying low-income women and men family planning services, which allow them to space pregnancies so they are better able to care for their children economically, makes no sense.
Denying prenatal care and family planning services to low-income families puts into motion a public health disaster we’ll reap for generations to come.

Paige Johnson is Vice President of External & Governmental Affairs at Planned Parenthood of Central North Carolina.