Health Care Reform

Mamas on Bedrest: Mamas With No Money and No Insurance

January 23rd, 2013

I live in Texas, not by choice but by circumstance.

As such I watch, with utter disgust, the Texas legislature cut and defund programs that have significant impact on women and children. The mantra here in “The Great State of Texas” is that “We pull ourselves up by our own boot straps and we take care of our own.” The sad truth is that those who can afford boots may in fact be able to pull themselves up by the straps, but for many hardworking Texans, it’s a struggle to make it from day to day and Texas is not doing a very good job of “taking care of its own.”

What many hardworking Texans don’t know is that with the passage of the Affordable Care Act, (ACA) there are federal funds available for each state to utilize so that they can increase the number of citizens who have access to health care. The funds typically go to support Medicare and Medicaid programs. Texas Governor Rick Perry is on the record as vehemently opposing the ACA and has vowed not to accept any federal funds. By rejecting these funds, Governor Perry ensures that some 6.1 million Texans remain uninsured.

Now I am in favor of everyone having his or her own opinion about government and the law. However, I think that when you are in a position of authority and you are making decisions for the general population, you need to step back from your personal views and look at what will be in the best interest of the greater population. Governor Perry and many Republicans vehemently oppose the ACA. However, it is the law and as such, there are provisions within the law that actually benefit a lot of people. In particular, the fact that the federal government has set aside funds so that the individual states can access these funds and use them to insure and care for their constituents is a good thing. Stubbornly denying the funds because you, a wealthy and well insured government official, have a philosophical difference with the government (okay, let’s be frank, the President!), and will as a result deny help to millions of your constituents is deplorable.

So why am I bringing this up on Mamas on Bedrest & Beyond? Because here in Texas, we have a large number of mamas who are either under-insured (their policies don’t cover maternity care) or they are uninsured. Texas also has some of the highest infant and maternal mortality rates in the United States and these rates are even higher for mamas of color. Women should not have to decide between keeping a roof over their heads and whether or not to start a family. The two should not be mutually exclusive. Mamas (and any children that they may have) need health care coverage and Texas Medicaid is struggling. Federal funds could go far in assuring that many hardworking Texans have access to safe, quality health care. A common misconception is that people on Medicaid are slackers, sitting about waiting for a handout. While this may in fact be true of some of the people receiving Medicaid benefits, there are just as many hard working people working low paying jobs that don’t provide (health care) benefits. These folks deserve to have access to quality health care.

But there are some really great folks out there working to ensure that all Texans, but mamas and babies in particular, have access to quality health care. In a bold move, Mamas of Color Rising has started MamaSana, an all volunteer free pregnancy clinic here in Austin. Mamas of Color Rising has also been instrumental in challenging the Texas Medicaid system to do more to support low income/mamas of color; petitioning the Texas Medicaid system to change it’s rules so that Licensed Professional Midwives will be able to attend births for low income/mamas of color and be reimbursed by TX Medicare, they have advocated for mother friendly birth practices for low income women and they have created a movement to ensure that all women have access to the best possible perinatal care, provided by caring health care providers and are aggressively pressing the Texas legislature to support their efforts. You can learn more about Mamas of Color Rising’s work here.

Here in Texas we are going to have to be vigilant and vocal when it comes to health care. We residents, constituents, have to continually press the legislature and the Governor to do the work of the people-and to work for the people. No matter what he may think of the Affordable Care Act or President Obama, Texans need a strong Medicaid program- many mamas and babies depend on it. And it is an ill conceived plan to refuse federal funds based a stubborn, prideful, philosophical difference-which in the end will have no effect on you or the quality of your life, but will greatly impact the lives of millions of others.

Mamas on Bedrest: $5 Billion on Moms and Babies!

January 9th, 2013

$5 Billion dollars.  Yes that’s Billion with a “B”.  That is the amount of money that the United States could potentially save annually on medical costs related to maternity care according to  The Cost of Having a Baby in the United States, new study published by Childbirth Connection, Catalyst Payment Reform and Center for Healthcare Quality and Payment Reform. The study was prepared by Truven Health Analytics and released January 7, 2013.

It’s no secret that the US healthcare system is in deep trouble and if it continues in its current iteration, it could very well bankrupt the entire country in the not too distant future. With the passage of the Affordable Care Act, the federal government made an attempt at reducing costs while at the same time making health insurance more available to more Americans. But it is safe to say that no one thinks that the ACA in its current form will be the answer to all that ails our flailing healthcare system. In an attempt to see where there are potential cost savings, several different agencies (public, private and non-profit) have undertaken studies to evaluate the type and quality of care provided in the United States in different health care arenas. In this study, maternity costs were analyzed in an effort to determine where there are not only potential cost savings in maternity care, but also potential reductions in risks to maternal and fetal/infant health.

The study is presented in an 86 page document.  One of the most remarkable findings is the fact that there are roughly 4 million babies born in the US annually and now a full one third or 33% are born via Cesarean section. This represents a 50% increase in cesarean deliveries in the last decade, and many cesareans performed are not medically necessary. Unnecessary  cesarean sections have been shown to increase health complications for both mother and baby.  But what was found in this study is that cesarean sections dramatically increase the cost of maternity care. According to the study,

“For the commercially insured, the average cost of a birth by c-section in 2010 was $27,866, compared to $18,329 for a vaginal birth.  Medicaid programs paid nearly $4,000 more for c-sections than vaginal births.  If the rate of c-sections were reduced from 33% to 15% (the World Health Organization recommends a c-section rate of 15% or less), national spending on maternity care would decline by more than $5 billion.”

The study also found that the cost of care for mamas increased 40% from 2004-2010 and this did not include costs of infant care, and also noted wide variation in costs from state to state and within states.  According to Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform (CHQPR),

“Maternal and newborn care together represent the largest single category of hospital expenditures for most commercial health plans and state Medicaid programs, so reducing maternity care costs provides a major opportunity to reduce insurance premiums for employers and to make Medicaid coverage more affordable for taxpayers.”

Another startling finding (in my opinion) is the fact that the uninsured may be charged. According to the study,

“Uninsured parents could be charged over $50,000 for a baby born by c-section and over $30,000 for a baby born by vaginal birth.  Average provider charges for a c-section in 2010 were $51,125, but commercial insurance plans only paid $27,866, 55% of what an uninsured patient could be asked to pay.”

Other startling findings:

  • Vaginal births cost $18,329; c-sections cost $27,866 (for the commercially insured, 2010) and these costs are substantially more for the uninsured.
  • Medicaid, which pays for over 40% of all births, paid nearly $4,000 more for c-sections than vaginal births.
  • If the current national rate of c-section were reduced from 33% to 15% (the World Health Organization recommends a rate of 15% or less), we could save $5 billion!
  • The cost of maternal care (not including newborn care) jumped an incredible 40% between 2004 and 2010 for the commercially insured.
  • The total commercial payments for care of newborns were $5,809 for babies delivered vaginally and $11,193 for cesarean births.  Total Medicaid payments for newborn care were $3,014 for vaginal births and $5,607 for cesarean births.  Reducing the rate of prematurity among infants could significantly reduce these costs.
  • The largest share of all combined maternal-newborn costs goes to pay for hospital or other facility costs regardless of the type of birth.  59% of total maternal and newborn care costs for vaginal births are used to pay facility fees, and 66% of costs for c-sections are for facility fees.  Similarly, the hospitalization phase of childbirth consumed from 70% to 86% of all maternal and newborn care costs, depending on payment source and type of birth.
  • There is significant variation in cost within and across states.

If the United States is serious about health care reform, obviously maternity care reform has to be at the top of its list! If pulling the US cesarean section rate in line with World Health Organization recommendations would truly result in a savings of $5Billion dollars, we should be seriously looking at ways to reduce the number of cesarean sections performed. Likewise, since hospital fees represent more than 70% of maternity care costs, it behooves us as a nation to consider increasing the availability and accessibility of birthing centers and, for those low risk women, home births. Many other countries utilize nurses and other health care providers to provided additional care to mothers and babies in their homes before and after birth (The models upon which Mamas on Bedrest & Beyond is designed!) which has been shown to greatly reduce the numbers of hospital admissions and care costs. The US has the means, the skills and expertise and the workforce (talking about A LOT of potential jobs here!) to provide such care and hence, further reduce the cost of maternity care and the burden on the US health care budget. If as a nation the US fails to implement of these recommendations, we will continue to face spiraling out of control maternity care costs, and,  more tragically, more perinatal complications, catastrophes and deaths of mamas and babies.

Childbirth Connection is a national not-for-profit organization founded in 1918 as the Maternity Center Association.  Its mission is to improve the quality and value of maternity care through consumer engagement and health system transformation.

Catalyst for Payment Reform is an independent, non-profit organization working on behalf of large employers and other healthcare purchasers to catalyze improvements in the way healthcare services are paid for and to promote better and higher value care in the United States.

The Center for Healthcare Quality and Payment Reform is a national policy center that encourages comprehensive, outcome-driven, regionally-based approaches to achieving higher-value healthcare.

Mamas on Bedrest: Make Your Voice Count-VOTE!

October 29th, 2012

I went to vote today, early,  and was surprised that I had to wait in line for about 20 minutes before casting my ballot. They say that this year’s presidential election is going to be one of the tightest in history. The margin of victory is likely to be the smallest every. Every vote counts, so Mamas on Bedrest, make your voice count-VOTE!

Now I know that some of you will be put off by the fact that I am making a “political statement” on what is “supposed to be a health care information website”. Well, as they say, the personal is in fact political. What occurs in this election will have far reaching implications for all Mamas on Bedrest. This election is about more than who will be president and who will run congress. As it relates to Mamas on Bedrest, the following issues are up for grabs:

The Family Medical Leave Act (FMLA): The United States is the only “industrialized” nation that offers no paid time off for workers to care for their own illnesses, a family member who is ill or to have/bring home/bond with a child (through birth or adoption). The FMLA only provides workers with 12 weeks of unpaid leave with guaranteed job security, i.e. no job loss. After those 12 weeks, employers are free to fire employees and at no time are employers obliged to offer any sort of paid leave. While some employers will offer some paid time off, it varies from employer to employer and dramatically from state to state. What is typically uniform is that workers in the lowest paying jobs-often those who need their jobs the most-are at the greatest risk of losing income, financial security and their jobs. If you would like to see FMLA changed, see the work of the National Partnership for Women and Families, MomsRising and WorkingMother Magazine. Also, VOTE and let your elected officials know that this is an issue that is important to you!

Mandatory Obstetrical Care: Now I can hear some of you saying, Whaaaaat????  Yup, many of our mamas became pregnant only to find out that obstetric care is not part of their health insurance policy and care had to be purchased (prior to pregnancy of course!) as a separate rider on their health insurance policy.  So imagine the strain that this places on the family finances when mama has a complication requiring her to be on bed rest?  Yes, I think you get the picture. The Affordable Care Act (ObamaCare) covers obstetrical care. If you think that this is a good thing, VOTE accordingly.

Education: The Department of Education has been targeted for budget cuts as well as complete closure. While our public schools are having their problems, without them, many children will be without any sort of education. Regardless of whether your children (or prospective children) will go to public, private or homeschool, education is an important element for our nations citizens. Voice your VOTE accordingly.

Healthcare Research: The National Institutes of Health grants millions of dollars annually to researchers studying a wide variety of health issues and diseases. Wouldn’t it be great if they allocated some additional funds for research on high risk pregnancy prevention? The federal government in part determines what gets studies by where they allocate funds. If you want more research and treatments for the conditions leading to bed rest, VOTE, make your voice known and let your elected officials know what is important to you.

Medicaid: Thousands of women are uninsured and receive their health care by the government subsidized program Medicaid. While the care is definitely not at the level of private obstetrical care, it is prenatal care none the less; prenatal care that many women would otherwise not have access to and be at increased risk of pregnancy complications, preterm labor, preterm birth and a premature infant with potentially life long health complications. While I agree that the Medicaid program leaves much to be desired, it is providing some benefit. Additionally, it’s a lot easier to fix a broken system than to try to get a whole new system entirely. If you don’t believe me, ask the women of Mamas of Color Rising here in Austin. They worked with several concerned groups and presented a rules change to the Texas Medicaid. The rules change is still being deliberated, but if it passes, Texas women receiving Medicaid will be able to receive prenatal care from and be attended by certified professional midwives, and those midwives will be reimbursed by medicaid. Mamas of Color Rising has also help start a free prenatal health clinic.  To learn more about Mamas of Color Rising, listen to this podcast interview with co-founder Paula Rojas.

These are just some of the issues that come to mind when I think of Mamas on Bedrest. I am sure that there are others, and do correct me on any thing that I have left out or you feel misrepresented. However, don’t miss the point of all of this-VOTE!

I want to end this post with something to think about. In the late teens and early 1920’s, thousands of women took a stand and demanded the right to vote. Some of them were beaten, many were arrested and many even died so that we now have the right to vote.

In the 1960’s, African Americans were the next sub segment of the US population to demand the right to vote. (without absurd, extraneous requirements and qualifications). They marched, they were attacked by dogs, they were drenched by fire hoses and many died in the cause of the Civil Rights act.  When I think of all that so many Americans have gone through so that I have the right to vote, it seems beyond disrespectful to me that I wouldn’t show up at a local voting center and cast my ballot.

But I’m on Bedrest! No worries. Here’s a few ways that you can vote.

Stop by and vote early on the way home from your next OB visit (If it’s on or before November 6th). Since it’s probably your only outing of late, see if you can extend it a bit and stop by an early voting center. The grocery store at which I voted this morning even had chairs for those unable to stand and a voting booth that had a chair and sat low enough for those in wheel chairs.

Absentee Ballot. Here in Texas, you have until tomorrow to request and absentee ballot. The cut off is likely different in different states, so contact your state’s voting board and see if you can still obtain a ballot. In some areas, someone can pick up the ballot for you. Most places will mail you a ballot. Absentee ballots typically have to be in to the election officials by the close of the polls on voting day, so if you intend to vote absentee, get your ballot ASAP and get it in to your state election officials. (Note: someone can also hand deliver your ballot for you! Check with your local officals.)

Ladies, I’m not telling you who to vote for, but I am sharing with you some issues important to Mamas on Bedrest. The bottom line is that you need to vote. This is not the year to sit things out because you are on bed rest. You can and should still vote. In an election where the margin of victory is estimated to be mere points, every vote will certainly count. So “stand up” and be counted. VOTE!

Image Courtesy of Brian Petty Designs.