SHELTON, Wash. - It’s one of the most vexing problems state lawmakers face: how to curb the rising cost of healthcare. In Washington, there’s one specific line item in the healthcare budget that’s startling, but few at the Capitol are talking about: taxpayers now foot the bill for more than half of all births in Washington. But why is that number is so high?
At Mason General Hospital northwest of Olympia, a newborn baby protests as a nurse checks his temperature and his diaper. Jack arrived three weeks early after his mom – Carly Earles – endured a miserable pregnancy.
“A lot of vomiting, a lot of hospital stays, a lot of IV fluids, nausea medicine,” she says.
Through it all, Earles’ medical care was covered by Medicaid. That’s the joint state-federal health care program for the poor. It paid for more than half of the nearly 86,000 births in Washington in 2011.
“I’m sure there’s plenty of people that don’t think that the state should pay for it," Earles says. "But things happen and you don’t have insurance.”
Earles, who is 28, says what happened in her case was her IUD failed.
“Surprise," she says. "He was our surprise.”
Earles also has a six-year-old daughter named Hailey. She works part time in a church daycare. Her husband just got full-time work as mechanic after years of unsteady jobs. They have no insurance. So, government funded coverage was their only option.
Earles is a typical Medicaid patient says Marcia Rohlik, an administrator at Mason General.
“Working poor is a lot of this," Rohlik says. "You know the uninsured working. I mean, yes, there is a sub population, but it’s not the classic welfare mom. Those are more the exception than the rule.”
State statistics bear that out. The majority of women whose pregnancies are covered by Medicaid earn too much money to qualify for welfare. One other stat that also runs counter to the welfare mom stereotype: most Medicaid deliveries are for a first or second child.
“The women who remain, the ten to fifteen percent who are having their third or greater child is on the order of less than 4,000,” explains Dr. Laurie Cawthon, who crunches the numbers for Washington’s Department of Social and Health Services.
Most experts agree it makes good financial sense to provide prenatal care to pregnant moms who lack insurance. It saves money later on from complications. But this coverage doesn’t come cheap. In the last fiscal year Medicaid spent $700 million to care for moms and infants.
“Whatever side of the fence you’re on," Dr. Cawthon says. "It’s a very large amount of money.”
Especially when you consider this: The Department of Health surveys these new moms and asks them if their pregnancy was planned or unplanned.
“Just over half of women on Medicaid say that when they conceived their child they either wanted to be pregnant later or never,” explains Dr. Cawthon.
In other words, more than half of Medicaid births are the result of unintended pregnancies. Washington House Budget chair Ross Hunter says there are long term financial and human costs associated with so many babies being born into low income families.
“It’s just a huge relationship between poverty as a young kid and bad outcomes.”
Hunter, a Democrat, believes the state must provide services that help low income kids overcome the odds. But he also hopes the federal Affordable Care Act and its focus on primary care results in fewer unplanned pregnancies.
“What we’re hoping here is that by having a relationship with a doctor because you are there anyway, they can say here you can go get this, this and all of a sudden you have a set of options available to you that are much broader than just what’s available on the shelf in the drug store.”
Hunter and most Democrats support expanding Medicaid under the Affordable Care Act. Washington legislative Republicans say they haven’t ruled that out, but want to proceed carefully. We reached out to several Republicans for this story, but all declined to be interviewed. Recently, Washington expanded its free contraception program – Take Charge – to include women and men who earn up to 250 percent of the poverty level.
Back at Mason General Hospital, Carly Earles picks up her baby Jack and holds him close. She makes no apologies about having another child – even if he was a surprise and even though she and her husband are uninsured and make so little that they qualify for food stamps.
“I know that I’m a good mom and I know that I take care of my kids," Earles says. "And I’ll take care of Jack just as well as I have Hailey and I don’t think that being on poverty line is making me less of a parent.”
Earles is grateful Medicaid was there when she needed it. Next time she needs medical care she hopes she’ll have private insurance. Her husband’s new mechanic position offers coverage after six months on the job.
On the Web:
Washington Medicaid - Washington State Health Care Authority