Six months after Nebraska restored prenatal care services to low-income pregnant women after a bitter fight over benefits for illegal immigrants, health clinics are reporting an uptick in the percentage of women seeking medical care in the crucial first trimester of pregnancy
LINCOLN, Neb. (AP) - Six months after Nebraska restored prenatal care services to low-income pregnant women after a bitter fight over benefits for illegal immigrants, health clinics are reporting an uptick in the percentage of women seeking medical care in the crucial first trimester of pregnancy.
The percentage of pregnant woman who seek first-trimester care during their first visit to the OneWorld Community Health Center in Omaha has increased from an average of 78 percent before the coverage was available to 85 percent in the last four months of 2012. The remainder seeks care during later stages of pregnancy.
"In terms of coverage, it has made a huge difference in our ability to reach women in that first trimester," said Dr. Kristine McVea, the center's chief medical officer. "When there was no Medicaid coverage, we had a problem with women not only seeking care late in their pregnancy, but also skipping appointments. They couldn't afford it."
Restoring state-funded prenatal care services was one of the most emotionally charged debates for Nebraska lawmakers last year. The women were disqualified from Medicaid coverage in 2010.
Senators narrowly overrode Gov. Dave Heineman's veto, 30-16, and reinstated the benefit for low-income women, many of whom were illegal immigrants. Heineman was so angry that he later said lawmakers didn't deserve a pay raise that was set to appear on the November ballot.
The issue also divided lawmakers who argued that the issue was foremost about unborn children, who have no immigration status, and those who cast it as a tax giveaway to illegal immigrants. The proposal was backed by a coalition of religious, anti-abortion and health groups.
Lawmakers will consider another effort to end the program this session.
At the OneWorld Community Health Center, McVea said rates historically have moved about 2 percentage points year-to-year. When the services were revoked in 2010, the number of women who sought first-trimester care plunged from 82 percent to 60 percent.
Doctors at the Nebraska Medical Center have also noticed an increase in women who are willing to seek help earlier for pregnancy-related health problems, said Dr. Teresa Berg, a maternal and fetal medicine specialist.
The Omaha clinic charges the women based on their ability to pay.
McVea said the center treated a handful of women who ended up losing their newborns due to simple health problems, such as a urinary tract infection.
"If they had come in and gotten $7 worth of antibiotics, they would not have been born prematurely," McVea said. "We're not seeing those kinds of high-risk situations anymore. Every day, you felt like you were doing things as a clinician that were unsafe and that put the baby's life at risk."
Nebraska offered the state-funded prenatal care services to 1,057 women statewide between July 19, when the law went into effect, and Dec. 31, according to the state Department of Health and Human Services. The state has spent $434,168 on services in that time, but the cost might increase because clinics have up to a year to file claims.
Sen. Charlie Janssen, of Fremont, a vocal opponent of illegal immigration, has introduced a bill this year to repeal the law. And in his proposed two-year budget to lawmakers, Heineman recommends pulling $786,000 in yearly funding for the services.
A spokeswoman for Heineman, a Republican, said the governor supports Janssen's bill.
Janssen said he doesn't oppose prenatal care services, but he didn't want taxpayers to cover the cost for people who are in the country illegally. Heineman has argued that allowing the benefits at public expense rewards illegal behavior and diverts money from services for legal residents. None of Nebraska's border-states offer prenatal care services to illegal immigrants.
"Certainly, I am an advocate of prenatal care," Janssen said. "I have a beautiful young daughter, who's 3 1/2 months old. She had prenatal care, which her mother and I paid for. I don't begrudge anybody for that. I just think that the taxpayers of Nebraska should not be on the hook for people who came here and broke the laws, and now are being encouraged to come from our border states to receive free medical care."
The bill faces long odds. Janssen's proposal was sent to the Legislature's seven-member Health and Human Services Committee, four of whom voted in favor of restoring prenatal care services last year. The other three members were just elected and didn't participate in last year's debate.
On top of that, 25 of the 30 senators who voted for the override are still in the Legislature - a majority that can ensure the bill isn't approved.
Nebraska is one of 15 states that offer taxpayer-funded care directly to unborn children, who have no immigration status in the eyes of law, according to the Kaiser Family Foundation. The others are Arkansas, California, Illinois, Louisiana, Massachusetts, Michigan, Minnesota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Washington state and Wisconsin.
"It's highly cost-effective to do this," said Alina Salganicoff, the women's health policy director for the foundation. "It's a smart investment for a state to try to do everything it can do to support a pregnant woman so that she has a good outcome."
Health-policy experts said eliminating the prenatal care benefits could affect other aspects of public health.
Several years ago, California experienced a federal crackdown on immigrants at public health clinics, said Ann Morse, an immigration-policy expert with the National Conference of State Legislatures. Even after the pressure on the clinics eased, she said, many immigrants were reluctant to return when they needed medical help.
"It took them forever to rebuild that trust - that belief that you could go back," Morse said. "It's one of the be-careful-what-you-wish-for scenarios. Once you scare people away from getting care, it stops being about prenatal care. It starts being about public health, and people not getting immunizations or going to doctors."
(Copyright 2012 by The Associated Press. All Rights Reserved.)
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