March of Dimes Senate Testimony - Uninsured Pregnant Women: Impact on Infant and Maternal Mortality What follows is a transcript of testimony given by Dr. Nancy Green, medical director of the March of Dimes Birth Defects Foundation, before the U.S. Senate Committee on Health, Education, Labor and Pensions October 24, 2002.
Mr. Chairman, I am Nancy Green and I am the Medical Director for the March of Dimes Birth Defects Foundation. I am pleased to be here today to discuss with you the importance of providing all pregnant women access to health insurance coverage and a comprehensive set of maternity services. I want to salute you, Mr. Chairman, and seventeen of your colleagues for sponsoring legislation that would give states the option of covering income eligible pregnant women 19 and older through State Children’s Health Insurance Programs (SCHIP). We would like to especially thank Senators Bond, Lincoln and Corzine who recently joined you on the Senate floor to discuss the need for S. 724.
President Franklin Roosevelt established the March of Dimes in 1938 to fight polio. The March of Dimes committed funds for research and within 20 years Foundation grantees were successful in developing a vaccine to prevent polio. The March of Dimes then turned its attention to improving the health of children through the prevention of birth defects and infant mortality. As you might expect, providing coverage to both pregnant women and infants is a policy priority and especially pertinent to the advancement of our mission because in January we will launch a $75 million multi-year campaign to address the growing problem of prematurity.
Today, the Foundation has more than 3 million volunteers and 1,600 staff members who work through chapters in every state, the District of Columbia and Puerto Rico. We are a unique partnership of scientists, clinicians, parents, business leaders and other volunteers and we work to accomplish our mission by conducting and funding programs of research, community services, education and advocacy.
At the March of Dimes, our overarching goal is to improve the health of mothers and children. This is why we are so concerned about improving access to health coverage for pregnant women and their newborns.
The Problem of the Uninsured Mr. Chairman, lack of health coverage continues to be a significant problem for many Americans. The Census Bureau recently reported that 41 million Americans were uninsured in 2001. Particularly troubling, Census Bureau data commissioned by the March of Dimes show that in 2001, 11.5 million women (18.7 percent) or nearly one in five women of childbearing age (15-44) went without health insurance – a higher rate than other Americans under age 65 (15.8 percent). That is, some 28 percent of uninsured Americans are women of childbearing age. Hispanic women in this age group are almost three times as likely as whites to be uninsured – 38 percent compared to 13 percent respectively. Native American (30 percent), African-American (23 percent) and Asian (20 percent) women were also likelier than whites to be uninsured. New Mexico (32 percent) and Texas (28 percent) had the highest rates of uninsured women of childbearing age for the 1999-2001 period according to the U.S. Census Bureau, compared with a U.S average of 18 percent for these years.
Since the mid-1980’s expanded Medicaid eligibility for pregnant women has resulted in better rates of coverage for them than for women in general. The Congressional Budget Office, citing in part March of Dimes supported research, estimates that about 1.7 million pregnancies are covered each year by Medicaid. But as the data indicate, considerable room for improvement remains.
Health Insurance Makes a Difference Numerous studies have shown that having insurance coverage affects how people use health care services. In particular, the uninsured are less likely to have a usual source of medical care and are more likely to delay or forgo needed health care services.
In a report issued earlier this year by the Institute of Medicine, researchers concluded that “[L]ike Americans in general, pregnant women’s use of health services varies by insurance status. Uninsured women receive fewer prenatal care services than their insured counterparts and report greater difficulty in obtaining the care that they believe they need. Studies find large differences in use between privately insured and uninsured women and smaller differences between uninsured and publicly insured women.” A study funded by the March of Dimes and cited by the Institute of Medicine in its report shows that some 18.1 percent of uninsured pregnant women in 1996 reported going without needed medical care during the year in which they gave birth. That compares with 7.6 percent of privately insured pregnant women and 8.1 percent of pregnant women covered by Medicaid.
Mr. Chairman, we know pregnancy represents a significant cost to young parents. These families, many of whom work in small businesses that don’t provide health insurance, face significant costs even with the healthiest pregnancies, and for families with a problem pregnancy, the financial impact can be devastating. Without access to health insurance, many pregnant women will delay seeing a doctor and getting the prenatal care they need. As the report that accompanied legislation passed by the Senate Committee on Finance stated, “[R]ecent studies have shown that infants born to mothers receiving late or no prenatal care are more likely to face complications which can result in hospitalization, expensive medical treatments, and increased costs to public programs. Closing the gap in coverage between mothers and their children will improve the health of both, while reducing costs for taxpayers.”
The March of Dimes’ objective is to reduce the number of uninsured pregnant women and children and to improve access to medical care. As you know, the March of Dimes supports elimination of any income eligibility disparities between mothers and newborns. To meet this objective, the Foundation has worked throughout this Congress to obtain support for a modest, incremental step to help improve access to health services for uninsured pregnant women by amending SCHIP. We support giving states the flexibility they need to cover income-eligible pregnant women age 19 and older, and to automatically enroll infants born to SCHIP-eligible mothers. By establishing a uniform eligibility threshold for coverage for pregnant women and infants, states will be able to improve maternal health, eliminate waiting periods for infants and streamline administration of publicly supported health programs. Currently, according to the Department of Health and Human Services’ Centers for Medicare and Medicaid Services and the National Governors’ Association, 36 states and the District of Columbia have income eligibility thresholds that are more restrictive for women than for their newborns. Encouraging states to eliminate this disparity by allowing them to establish a uniform eligibility threshold for pregnant women and their infants should be a national policy priority.
Mr. Chairman, in January and on several occasions throughout the year, we were pleased that on behalf of the administration HHS Secretary Thompson endorsed legislation to achieve this important objective. However, the March of Dimes is disappointed to learn that the administration has apparently withdrawn its support for legislation and instead will rely on a regulation issued on October 2, 2002 that permits states to cover unborn children. Specifically, we are deeply concerned that final regulation fails to provide to the mother the standard scope of maternity care services recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). Of particular concern, the regulation explicitly states that postpartum care is not covered and, therefore, federal reimbursement will not be available for these services. In addition, because of the contentious collateral issues raised by this regulation groups like the March of Dimes will find it even more difficult to work in the states to generate support for legislation to extend coverage to uninsured pregnant women. We agree with the Secretary about the value of prenatal care to achieve healthy birth outcomes. In fact, as recently as January 31, 2002, Secretary Thompson has said that “[P]renatal care for women and their babies is a crucial part of the medical care every person should have throughout the life cycle. Prenatal services can be a vital, life-long determinant of health, and we should do everything we can to make this care available for all pregnant women. It is one of the most important investments we can make for the long-term good health of our nation.” We couldn’t agree more. When a new mother goes home following delivery, the March of Dimes wants to be sure that she is healthy enough to support herself, to breast feed and care for her newborn, and to participate fully in her family’s life.
Solutions Mr. Chairman, you and your Finance Committee colleagues approved S. 724, the “Mothers and Newborns Health Insurance Act of 2002,” in early July and similar legislation is pending in the House of Representatives. By including important provisions from your bill, S. 1016, the “Start Healthy, Stay Healthy Act,” the Finance Committee-approved legislation would accomplish these important policy priorities. By doing so it would bring the SCHIP program into alignment with every other federal health insurance program all of which extend coverage to pregnant women and their babies.
The provisions of S. 724 that are particularly important to advancing the mission of the March of Dimes are:
Allowing states the flexibility to extend SCHIP coverage to pregnant women 19 and older.
States would be able to receive federal financing to help provide health coverage for income-eligible pregnant women. No waiting period would apply for participation in the program, and coverage of the mother would extend for at least two months following the birth of the child – the postpartum coverage timeframe recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). Estimates of the annual impact of this change in law suggest that some 30,000 to 40,000 uninsured pregnancies could be covered.
Automatically enrolling newborns whose mothers are enrolled in SCHIP and 12 month continuous coverage.
Automatic enrollment of newborns is important to avoid gaps in coverage for medically vulnerable infants. Enrollment of infants born to mothers eligible for SCHIP should begin the moment the child is born. This is especially important when a baby is premature, has a birth defect, or is in other ways medically fragile. In addition to automatic enrollment in SCHIP, newborns would remain enrolled in the program for one year. Many of these newborns would be eligible for coverage under current law, but often are not enrolled on timely basis. S. 724 establishes continuity of care for infants by guaranteeing coverage for the first year of life when access to health care services is particularly important for a healthy start in life.
Outreach Improvements
In addition to the positive effects of enrolling pregnant women in SCHIP, S. 724 includes provisions to improve outreach. Research and state experience suggests that covering pregnant women is a highly successful outreach mechanism for enrolling older eligible children. Several states have found that expanding coverage to uninsured parents results in increased enrollment of eligible children (including California, Illinois, Kentucky, Nevada, Rhode Island, and Wisconsin).
Conclusion At the March of Dimes we believe that improving access to health care for uninsured pregnant women and their infants should be a national priority. S. 724 has broad bipartisan support in both Houses of Congress and the National Governors’ Association has called on Congress to give states this option. In addition, twenty-six national organizations have endorsed this initiative. In short, Mr. Chairman, S. 724 would give us, and other organizations committed to improving the health of women and children, the opportunity to work in states across the country to expand access to comprehensive maternity services as recommended by obstetricians and pediatric practitioners.
Once again, on behalf of the March of Dimes thank you for your commitment to improving the health of children and their families and for this opportunity to testify on the issues of critical importance to pregnant women and infants.
I would be pleased to answer any questions the Committee may have.
References 1U.S. Census Bureau. Health Insurance Coverage 2001. September 2002.
2Congressional Budget Office. “Cost Estimate: S. 724 Mothers and Newborns Health Insurance Act of 2002.” October 11, 2002.
3Kaiser Commission on Medicaid and the Uninsured, Uninsured in America: A Chart Book, May 2000.
4Institute of Medicine. Health Insurance Is A Family Matter. National Academies Press. 2002.
5Bernstein, A. “Insurance Status and Use of Health Services by Pregnant Women.” March of Dimes. December 1999.
6Report 107-233. “Mothers and Newborns Health Insurance Act of 2002.” Committee on Finance, United States Senate. August 1, 2002.
7Centers for Medicare and Medicaid Services. “The State Children’s Health Insurance Program Annual Report, October 1, 2000 – September 30, 2001. February 6, 2002, and National Governors’ Association. “Income Eligibility for Pregnant Women and Children.” MCH Update. May 17, 2002.
842 CFR Part 457. “State Children’s Health Insurance Program; Eligibility for Prenatal Care and Other Health Services for Unborn Children; Final Rule.” Department of Health and Human Services, Centers for Medicare and Medicaid Services. October 2, 2002.
9“HHS Release – SCHIP Coverage for Prenatal Care.” Department of Health and Human Services. January 31, 2002.
10Mathematica Policy Research, Inc, “Implementation of the State Children’s Health Insurance Program: Momentum Is Increasing After a Modest Start: First Annual Report,” January 2001
Articles for parents, news, personal stories, and more! SUBSCRIBE>
