Should a state be required to provide prenatal care for women with undocumented status?

A bill under contention in Nebraska proposes joining 14 states and the District of Columbia in providing prenatal care for all pregnant, low-income women regardless of immigrant status under CHIP, the children's health insurance program.

It is authored by Republican Sen. Kathy Campbell, a long-time advocate for women and children, who says the bill is "morally right because all children deserve to be born healthy." Republican Gov. Dave Heineman opposes it, saying taxpayer-funded benefits should not reach people without legal citizenship.

The bill is also backed by organizations that span the spectrum of opinions on fetal and maternal rights.

Nebraska Right to Life argues that providing prenatal care improves the chances that a woman will choose to give birth rather than seek an abortion.

The organization said it would consider legislators' votes in making campaign endorsements.

Heineman told the state's bishops on March 4 that although he respected their view that denying coverage might lead some women to seek abortion, he would not support the bill. Roman Catholics represent one-third of voters in the state.

The bill is also backed by organizations such as Voices for Children in Nebraska, which advocates for pregnant women and children, the Nebraska Medical Association and every medical organization in the state, many of which support a woman's right to choose.

However, many individuals spoke out against the bill at a hearing of the Health and Human Services Committee Feb. 25, urging the legislature to create an environment that would force expectant mothers to return to their native lands by denying them prenatal care, jobs and housing.

'No Options'
"Immigrant women don't have options," said Jennifer Carter, director of the health care access program of Nebraska Appleseed, a not-for-profit law project in Lincoln that supports the bill. "Although most immigrants work, they lack health insurance because their employers don't provide it and they earn too little to afford to buy individual policies."

The decision, later this month, will need 30 of 49 votes to overcome Heineman's veto.

In a recent interview with Women's eNews, Campbell said the bill makes financial sense for Nebraska because children of undocumented mothers become citizens at birth and therefore eligible for state health programs.

"It is more economical for the state to pay a small sum for prenatal care than huge bills for a child who is born premature or with serious complications that could have been prevented and will require expensive interventions throughout life," said Campbell, an advocate for children for over 30 years.

Steven A. Camarota, research director of the Washington-based Center for Immigration Studies, say prenatal coverage of undocumented women is a matter of national concern.

"About 370,000 children--one out of 10 children born in the United States each year--is the child of an illegal alien," he said.

Camarota added that the federal government has no coherent immigration policy, "so states are left in the unenviable position of having to decide whether they should spend limited funds on prenatal care for future citizens of the state, medical care for legal residents, roads or other programs."

Federal Policy Change Impacts State
For more than 20 years, Nebraska provided prenatal care under its Medicaid program to all pregnant, low-income women regardless of their citizenship status. In November, the federal government notified the Nebraska Department of Health and Human Services that federal Medicaid policy does not allow coverage of an "unborn child."

The Centers for Medicare and Medicaid Services also advised Nebraska officials that the state could continue to provide prenatal care to pregnant women who do not qualify for Medicaid by covering unborn children under CHIP.

On March 1, Nebraska ended Medicaid benefits for 1,540 women, about 25 percent of the pregnant women eligible under the old rules. Seven hundred were U.S. citizens and legal immigrants and the other 840 were undocumented immigrants.

Expectant mothers who have undocumented status are already feeling the impact of the loss of Medicaid-supported prenatal care, said Dr. Kristine McVea, chief medical officer of the OneWorld Community Health Center in Omaha.

"In January, the state notified women who were newly pregnant and had applied for Medicaid that they would be ineligible for benefits," McVea said. "Many of these women have gone without care because there is a lack of facilities that can provide free or low-cost services where they live. Others have received basic care at community health centers like ours."

However, McVea said that their facility doesn't have ultrasound and other equipment needed to treat women who develop complications during pregnancy and are at risk for premature births.

An Institute of Medicine study found that every dollar spent on prenatal care for women at high risk of delivering a low-birth weight infant saves $3.38 in medical care expenditures. Hospital stays for premature births average 12.9 days and cost $15,100, compared to 1.9 days and $600 for a normal birth.

Campbell says shifting prenatal care coverage from Medicaid to CHIP will save Nebraska money.

"Providing prenatal care for women with undocumented status under the CHIP program would save Nebraska about $4 million a year because (federal) reimbursement under CHIP is higher than Medicaid," she said.

This article was contributed by Sharon Johnson who is a New York-based freelance writer.

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