Although Congress is in recess until November 12, the Senate Health, Education, Labor, and Pensions Committee held an October 24th hearing to discuss a new federal regulation that allows states to provide insurance coverage to “unborn children” through the State Children’s Health Insurance Program (SCHIP). Under the rule, which was implemented on October 2, the definition of child is expanded to include an unborn child, “including the period from conception to birth,” thereby allowing pregnant women to receive prenatal care through SCHIP.
Sen. Jeff Bingaman (D-NM) opened the hearing, saying that there have been numerous studies showing the importance of providing insurance coverage to pregnant women. “We, as a nation, would be remiss to not take the simple but critical step of increasing access the prenatal, labor and delivery, and postpartum care through the State Children’s Health Insurance Program…to help prevent birth defects and prematurity, the most common causes of infant death and disability, and maternal death and disability.”
Sen. Bingaman criticized the administration’s rule, saying that it failed to provide adequate treatment for pregnant and postpartum women. “During the postpartum period, women would be denied all health coverage from the moment the child is born,” because the treatment would not be for the child.
Sen. Bingaman also expressed his frustration with the administration for wavering in its support for the Mothers and Newborns Health Insurance Act (S. 724). The bill would allow states to provide optional SCHIP coverage to low-income pregnant women. Under the legislation, pregnant women whose children would qualify for SCHIP would be eligible for coverage during their pregnancy, delivery, and for 60 days postpartum. Their newborn babies would automatically be enrolled in SCHIP for the first year of their lives. The measure was approved by the Senate Finance Committee on July 11 and is sponsored by Sens. Christopher Bond (R-MO) and John Breaux (D-LA) (see The Source, 7/12/02).
The committee only heard testimony in support of S. 724 and in opposition to the administration’s rule. Representatives from the administration declined to testify before the committee.
Sen. Blanche Lincoln (D-AR) testified that S. 724 “could drastically improve the lives and health of thousands of women and children throughout our nation.” Noting that the U.S. ranks 28th in the world in infant mortality and 21st in the world in maternal mortality, Sen. Lincoln said, “When we are ahead of every other nation in almost every other arena, I am ashamed we have not taken a course of action that would prove to the rest of the world that we truly do value life in the country, and that we want to do all we possibly can to ensure the healthy delivery of children, as well as the health of their mothers.”
Sen. John Corzine ((D-NJ) agreed, telling the committee that “every week in our country, 8,500 children are born to mothers who lacked access to prenatal care.” In criticizing the rule, Sen. Corzine said, “The rule leaves shocking gaps in coverage for both women and children and will be virtually impossible for states to implement,” adding that the rule does not provide for postpartum care or other non-pregnancy-related medical care that may arise during a woman’s pregnancy.
Speaking on behalf of the American College of Obstetricians and Gynecologists (ACOG), Dr. Laura E. Riley expressed her strong support for S. 724, as well as her concerns about the recently implemented rule. Noting that S. 724 would ensure “access to comprehensive prenatal and postpartum coverage,” Dr. Riley added that the rule specifically excludes postpartum services from coverage. “Postpartum care is especially important for women who have preexisting medical conditions, and for those whose medical conditions were induced by their pregnancies, such as gestational diabetes or hypertension, and for whom it is necessary to ensure that their conditions are stabilized and treated,” she said, adding, “We at ACOG believe that it is unrealistic to exclude the mother and provide services solely to the fetus. It is impossible to separate mother-baby pairs and expect a good outcome for either of them.”
In particular, Dr. Riley noted that African-American, Hispanic, American Indian, and Alaska Native women are at the greatest risk for maternal mortality and said that “the regulation’s omission for postpartum coverage will disproportionately affect the very women that need the most help.”
Dr. Richard Bucciarelli of the American Academy of Pediatrics expressed concern that the regulation “falls dangerously short of the clinical standards of care outlined in our guidelines, which describe the importance of covering all stages of a birth—pregnancy, delivery, and postpartum care.”
In addition to noting the importance of postpartum care, Dr. Bucciarelli discussed the importance of health care during a child’s first year of life. “It is within the first year of life when the parents need the most assistance in dealing with their new child; it is within the first year of life that immunizations are most critical; and it is within the first year of life that making the correct diagnosis and initiating appropriate therapy is so important,” he said, praising S. 724 for including continuous coverage for children during the first 12 months of life.
While praising Secretary of Health and Human Services Tommy Thompson for recognizing that many pregnant women could not afford prenatal care and realizing that SCHIP may offer a solution, Lisa Bernstein of the What to Expect Foundation criticized the rule. “‘Fetal care’ and ‘prenatal care’ are not the same thing,” she said, adding, “This new regulation makes clear that fetal care is about the fetus first. ‘Extras’ like epidurals and pain medication will only be available if a case can be made that they are for the health of the fetus.”
In expressing her support for S. 724, Nancy Green of the March of Dimes said that the bill “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.”
