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Senate budget kicks pregnant women off of Medicaid

In 1988 North Carolina had the nation’s highest infant mortality rate. The state decided to tackle this tragedy in a variety of ways. One approach, championed in a bipartisan effort by Republican Governor Jim Martin, was to expand Medicaid coverage to pregnant women earning up to 185 percent of federal poverty level and creating a package of programs within Medicaid to ensure good maternity care and a safe delivery.

Pregnant women who qualify now get excellent care in Medicaid and we have made some progress with our infant mortality rates. The legislature is now set to roll back that progress.

One of the Senate budget provisions moves Medicaid eligibility for pregnant women down from 185 percent of federal poverty level to 133 percent of federal poverty level (about $15,000 in annual income). The rest of the provision is a poorly constructed attempt to provide political cover for this mean spirited move.

From committee discussions it’s clear that legislators think they are moving these women who currently qualify for Medicaid into private insurance on the new health benefits exchange. Some Senators suggest the women will then qualify automatically for subsidies and the state will cover the remaining, unsubsidized, part of their premium using Medicaid funds. Out-of-pocket costs for these pregnant women, the Senators say, will be capped thanks to Obamacare.

The problem with all of this is that Obamacare was not constructed with the idea that legislators would try to kick our state’s most vulnerable group of people out of Medicaid. In fact, health reform was built around an expansion of Medicaid. The claims made by Senators about what will happen to pregnant women are untrue. This “program” created by the Senate budget is an unworkable solution to a nonexistent problem.

Many women, for example, will either not qualify for premium subsidies in the exchange or not qualify for the state premium assistance. Let’s say a woman makes $17,000 a year with part-time work and buys a substandard insurance policy from her employer. We don’t have final rules about what constitutes “minimum essential coverage” but initial proposals do not require maternity care. So let’s assume the plan does not cover maternity care. Now the woman becomes pregnant. Her employer coverage does not cover her needs. She no longer qualifies for Medicaid. She could buy subsidized coverage in the exchange but she would still be required to pay thousands of dollars out-of-pocket. And, because she has “minimum essential coverage” at work, she is excluded from the new state program.

Also, it’s not true that her out-of-pocket costs are capped at $2,200 as some Senators claim. Out-of-network care, for example, does not count toward the cap. Neither do the costs of uncovered services. The questions about what it would mean to move these pregnant women to private insurance plans are too numerous to list. Here are just a few: Could a woman lose her private insurance plan? Could a provider refuse to treat a woman if she did not have her co-pay at the time of service? Does the woman get to pick her own exchange plan or does Medicaid choose for her? If a woman is “rated up” for having used tobacco products will the state cover that portion of the premium? Again, these are only a few of the many questions that should be asked. The provision, as I say, is unworkable.

The most disturbing part of the provision is that Senators did not take time to understand its shortcomings or to make it viable. It’s clear that they just wanted to kick pregnant women off of Medicaid and stick some political cover into the budget. They also get to try and score ¬†meaningless rhetorical points against Obamacare. But the conclusion is clear: if this proposal is in the final budget, more pregnant women will go uninsured and our efforts to improve infant mortality rates will suffer.

 

 

 

9 Comments

  1. marvin e. rouse

    May 23, 2013 at 4:19 pm

    Where are the women of the state on this issue. So much of the budget plan will hurt women and women headed families the hardest.
    Women have been so quiet on these subjects that one wonders if their votes matter.
    Perhaps, there should be a Women’s rally over Fathers’ Day weekend to protest this assault.

  2. David

    May 23, 2013 at 4:57 pm

    This article shows that the author either didn’t do his homework or is attempting to mislead.

    Firstly, under the ACA, part-time workers likely wouldn’t receive insurance from their employer. But if they did, the coverage must be deemed affordable and adequate under the law to foreclose the option of shopping on the exchange. That means things like: the cost for single coverage can’t be more than 9.5 percent of your income or the policy doesn’t cover at least 60 percent of your allowed medical costs.

    Second, and most importantly, you make it sound like there is a possibility that some plans won’t offer maternity coverage. That’s just not true. Maternity and newborn care is one of the 10 essential health benefits that is required of all health plans sold inside and outside of the exchange. Although businesses don’t necessarily have to abide by those same benefits (they’re judged based on the plan’s actuarial value), the Pregnancy Discrimination Act already requires businesses to offer maternity coverage.

    Third, you’re not giving an accurate picture of out of pocket costs. There are two protections for out of pocket costs: families from 100 to 400 percent of the federal poverty level qualify for tax credits to reduce premiums and families from 100 to 250 percent of FPL qualify for help in out of pocket costs for copays and deductibles. All told, out of pocket costs for women up to 133% of FLP will be limited to 2% of income, for 133-150% of FPL it will be limited to at most 4% of income, etc.

    And although you may cite certain far-flung exceptions, like a pregnant woman deciding to go out-of-network for services that are being provided in-network, in some cases ACA mandates still require that the plan cover the service and not impose cost-sharing.

  3. alma shaffer

    May 23, 2013 at 8:37 pm

    A Woman’s Rally over Father’s Day sounds like a great idea. Women are being shoved under the bus as polititions rush to reject Obamacare.

    Women must stand up for themselves. Please join the battle.
    Thank you.

  4. Adam Linker

    May 23, 2013 at 9:15 pm

    David,

    I’m not sure why you included your first comment but I’m glad you know something of the ACA.

    But, since you’ve done your homework, I’m sure you realize that I didn’t say if you get coverage at work you will be barred from the exchange. I said you would likely be barred from the new state program, as the program is linked to minimum essential coverage. As you know the rules on MEC have not been finalized but the proposed rule is extremely bare bones, and does not include maternity coverage.

    Also, as you know, there will be plenty of plans, especially in the first two years, that do not include the EHBs and do not adhere to reform regulations including grandfathered plans, plans that renew in December 2013 (which is the big push now), and stop loss plans.

    It seem that you realize out-of-pocket maximums are not absolute caps. Given that NC has almost nonexistent network adequacy laws, and given that networks will get much tighter in 2014, it is not far flung to suggest that women will rack up out of network costs.

    None of your comments address the giant list of questions that are still more concerning about choosing a plan, reconciling tax credits, tobacco surcharges, etc. Again, the plan is unworkable.

    For someone like me, the protections you mention are a tremendous benefit because they provide extra layers of security. But these protections were not designed to replace Medicaid for pregnant women. gain, the law contemplated the expansion of Mediaid, and even gave states the option of creating a Basic Health Plan, to help with the churn between Medicaid and private insurance. Not only did NC not expand Medicaid and not create a Basic Health Plan, we are kicking vulnerable populations off of Medicaid.

    I’ve done my homework and this is a bad idea.

  5. Frances Jenkins

    May 23, 2013 at 9:47 pm

    This is a bold faced lie of the left. Read the damn plan.

  6. Doug

    May 24, 2013 at 1:01 pm

    Frances,
    Even though they passed it without reading it….so they could read it later,,,,,they still have not read it.

  7. [...] Shifts pregnant women who earn at least 133 percent of the federal poverty level from Medicaid to the private health insurance marketplace being set up under the Affordable Care Act. [...]

  8. Frances Jenkins

    May 26, 2013 at 5:45 pm

    Why would anyone not want their own insurance policy rather then being on a government plan?

    David,
    You just say things with no merit.

  9. Amy O.

    May 27, 2013 at 10:27 am

    Frances,
    Because a lot of us working for big companies no longer get enough hours to afford the insurance they offer.