Help the babies
Medicaid expansion and boosting women’s care would help families — and state budget.
The most striking thing about a hospital’s neonatal intensive care unit, or NICU, is the quiet. The hush seems normal at first. Babies sleeping in rows of bassinets. Nurses and moms whispering. Softsoled shoes creaking on linoleum floors. No crying. No fussing. Just an unsettling quiet. This is the place where the tiniest newborns come when they’ve been delivered too early or too small, when they leave the warm, nurturing safety of their mother’s womb and enter a harsh world for which they are woefully unprepared — babies so tiny they don’t have the strength to cry.
Texas continues to hold its place above the national average in the number of preterm, low-birthweight babies, not a small problem considering that Texas has about 400,000 live births every year. Of these newborns, 12.4 percent are preterm — about 49,500 tiny babies. Not all are as early or as fragile as the NICU preemies, but all are at risk of difficult, perhaps lifelong health problems. One indication of their frailty is the cost of caring for them. According to Medicaid numbers, a healthy, full-term birth costs an average of $404. A premature baby without major problems costs $4,019, and an extremely premature birth costs $63,124. Medicaid covers 53 percent of all births in Texas, and preterm births account for 70 percent of those costs. The Texas Health and Human Services Commission (HHSC) estimates that a 1 percent reduction in NICU utilization would save the general revenue $3.1 million every year.
The best way to make a dent in these numbers is to ensure that the mother gets adequate medical care; her health, age and lifestyle choices are the most predictive risk factors for preterm or lowbirth-weight babies. Diabetes, obesity, hypertension, depression, youth and inadequate prenatal care — all put a pregnancy at risk. Texas Medicaid covers a woman during her pregnancy and up until 60 days after delivery. The baby will be covered until it reaches 18 years. Subsidized coverage under the Affordable Care Act is available for individuals above the poverty line ($33,465 for a family of four). Working-age adults below this income level would have been covered by Medicaid expansion, but our state officials continue to stonewall the program.
That’s the problem, of course. Low-income women who are diabetic or hypertensive and might get pregnant have very limited access to ongoing medical care. Fully 45.6 percent of the state’s pregnancies are unintended, but familyplanning services to help a mom space her pregnancies so that she is healthy enough to have a healthy, full-term baby have been dramatically reduced by the Legislature’s ongoing attack on Planned Parenthood, which has forced at least 82 women’s health clinics across the state to shut down. And if the U.S. Supreme Court had not slapped down elements of Texas’ harshly restrictive abortion law Monday in ruling against the state in Whole Woman’s Health v. Hellerstedt, more would have been forced to close, leaving the second-largest state with only nine.
We commend HHSC for two new programs to provide some health care continuity for new mothers. Beginning Friday, any new mom with yearly income below $44,124 for a family of four will automatically be enrolled for up to two years in a program called Healthy Texas Women. It provides screening for breast and cervical cancers, hypertension, diabetes and STDs. It also offers family-planning services, along with a wide array of birth control products. HHSC is also proposing a program to provide long-term — three to 10 years — contraception products to new mothers. Among teen pregnancies, 22 percent are repeats.
But these programs are at best a stopgap. They provide no medical treatments, except for some STDs. Without ongoing medical care, a mother’s uncontrolled diabetes or hypertension or opiate addiction is a danger to her infant. As long as Texas government officials continue to fight Medicaid expansion and to limit women’s access to family planning and screening by shutting down women’s health clinics, their complicity in this costly health care emergency will be undeniable. Once again we urge state officials to give up their vendetta against Planned Parenthood — yes you, Attorney General Ken Paxton and Lt. Gov. Dan Patrick — and to reconsider their recalcitrance on Medicaid expansion. If they can’t do it for the babies, they can do it for the budget.