Policy Punishes Unborn Children

Details: 03 December 2010

"Inappropriate punishment."

Those were the well-chosen words an obstetrician-gynecologist, whose practice is located in Columbus, used to describe Nebraska’s new policy—now nine months old—that denies government-insured prenatal-care services when an impoverished, pregnant woman is an undocumented immigrant.

In his testimony to a panel of state legislators on Nov. 19, the doctor was describing the consequences of the policy for the unborn children, who are undeniably innocent of any unlawful conduct. They are the victims of "inappropriate punishment."

For two decades or more, Nebraska provided medical-assistance coverage (Medicaid) for impoverished pregnant women regardless of their citizenship or immigration status. Nebraska policy regarded the unborn child as the recipient of the prenatal-care services, acknowledging the importance of prenatal care not only for his/her life in utero, but also as preventative care for the long term, following birth.

Late last year, the federal agency that governs the joint federal-state Medicaid program suddenly realized what Nebraska was doing. The policy’s long tenure notwithstanding, it was a no-no under federal rules. Undocumented immigrants are not eligible for Medicaid and unborn children are not recognized as beneficiaries of prenatal-care in their own right.

Among others testifying at the recent legislative hearing were the directors of the Good Neighbor Community Health Center in Columbus and One World Community Health Center in Omaha; both entities are Federally Qualified Health Centers, commissioned by a federal program to provide health-care services on a charitable basis and without attention to citizenship or immigration status. They testified that the constricted policy definitely has had repercussions: significant spikes in the number of uninsured, pregnant women seeking help, typically later in their pregnancies, without any prior prenatal care; undocumented women taking chances that complications won’t occur; births of more low-weight babies, most of whom did not receive adequate prenatal care; and increased requests for information about abortion.

The representative from the Columbus FQHC told legislators that after having no fetal deaths in the previous six years, the center has experienced four since March 1, the date the policy on covering prenatal care changed. Whether these stillbirths can be attributed to inadequate prenatal care is medically undetermined, but the context is real.

The representative of the Omaha FQHC related the case of an emergency in which a woman who had received no prenatal care prematurely delivered her baby at 20-weeks gestation; the baby did not survive.

An obvious, inherent consequence of eliminating a means of access to prenatal-care services was emphasized by several testifiers; namely, the long-term financial impact of health problems that can be prevented or mitigated by adequate prenatal care.

Termination of insured prenatal-care services for the unborn children of impoverished, undocumented women didn’t need to happen. For both the Governor and the state Legislature, an alternative was (and still is) quite available. These policy makers, whether by administrative or legislative action (or both) could have adopted the unborn-child option of the federal Children’s Health Insurance Program.

For children specifically, CHIP extends insurance coverage somewhat beyond regular Medicaid eligibility boundaries. Pursuant to the option, unborn children are included in the definition of children for purposes of insured health care.

What’s more, this coverage qualifies for federal cost share that is about 15 percent better for the state than the rate for regular Medicaid.

In 2010, the CHIP unborn-child option was rejected because the Governor and a majority of state legislators viewed the policy decision as an immigration issue more than a pro-life issue or a health-care issue.

Former U.S. Congressman John Cavanaugh, now executive director of the Bright Futures Foundation, was another who testified before the panel of legislators. He made the point that not a single positive result can be attributed to the policy change.

The Governor, numerous state legislators and other Nebraskans as well would probably beg to differ, on grounds that preventing "illegals" from receiving taxpayer-subsidized medical assistance is a positive result.

But that view fails to acknowledge and respect the individual humanity and dignity of unborn children, disregards their health in utero and post-birth consequences, and ignores the facts that unborn children have no immigration status and are innocent of violating any laws.

The result is inappropriate punishment.

Fortunately, CHIP’s unborn-child option is still available. The lamentable repercussions that have occurred since March cannot be reversed, but more extensive harm can be avoided by policy action.