Senate health bill puts many moms and babies at risk, says March of Dimes president

How would the current Senate Republican health care plan affect pregnant women, mothers and babies? Judy Woodruff speaks with Stacey Stewart, president of March of Dimes, about how many women depend on Medicaid to get prenatal care and have healthy pregnancies, and how early intervention and prevention programs can help reduce health care costs.

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    As Republicans in Congress struggle to reach agreement on a plan to replace the Affordable Care Act, we have heard from a variety of interested parties in recent weeks and months.

    They have included hospitals, the pharmaceutical industry, advocates for the homeless and those with disabilities, as well as lawmakers from both political parties.

    Tonight, we turn to the March of Dimes and its president, Stacey Stewart. It's a nonprofit that focuses on the health needs of mothers and babies, especially with regard to preventing premature birth, birth defects and infant mortality.

    Stacey Stewart, thank you very much for being here.

    So, what is your main concern with the Senate version of this health care reform plan?

    STACEY STEWART, President, March of Dimes: Well, the March of Dimes, as you mentioned, what we care about is the health of pregnant women and their babies.

    And our main concern with the Senate bill, as it's proposed, is that it would put at risk the health of many of those women and their babies. Medicaid today covers about half of all pregnancies in the United States and there are about 30 million children that are covered by Medicaid.

    Under what the Senate has proposed, about 6.5 million low-income women of child-bearing age would lose their coverage under Medicaid. And we think that that puts at risk those women in terms of them being able to access prenatal care and all the things they need to do to have a healthy baby, have a healthy pregnancy.


    So, about half of pregnant women in this country depend on government help in order to have a healthy pregnancy?



    So, what Medicaid covers is — it generally covers a lot of low-income women who are pregnant and making sure they have the help they need in prenatal care and also in delivering the baby.

    But what it also covers, and what a lot of people don't understand, is that, if a baby is born too soon, born premature, if a baby is born with low birth weight or a baby has defects, Medicaid also covers many of those babies as well. So it ends up covering a lot of the babies and providing the support that many women and families need to make sure they can have a healthy pregnancy and have the support that babies need if there are complications.


    I think there hasn't been a great deal of talk about prevention, but you were telling us that prevention is a very — is a big part of this.


    Well, I think one of the big conversations that is going on right now is, how do we stabilize the health market?

    And I think — how do we stabilize Medicaid and I think stabilize health care in general? And I think one of the conversations we really need to have as a country is, how do we begin to do even more, to put more of the emphasis on prevention and care earlier on, vs. having a system that really is funding a lot of chronic disease and illness?

    So, one of the reasons we focus so much on maternity coverage and prenatal care is because that's what happens to enable those women to have healthy babies. If they get the help they need, and certainly even before they get pregnant, if they are healthy before they even get pregnant, that is going to be what creates the best outcome for that baby.

    And so healthy women equals healthy babies. The more and more we can put more emphasis on early prevention efforts and fund a system that actually focuses on that, we think will improve health outcomes, reduce cost, reduce premiums, which is what I think everybody wants.


    Isn't it the case, though, Stacey Stewart, that, under traditional Medicaid, states are required to cover pregnancy, to cover prenatal care, to cover babies?

    So, even if Medicaid is scaled back, which looks like would be the case under the Senate plan, the Republican plan, they would still be required to cover women in these circumstances, wouldn't they?


    Well, the problem is, is that with reductions as they're proposed, we're not exactly sure if — how much of the need would be covered.

    That's always a question. And with women coming off of Medicaid coverage as a result of the pullback of the expansion of Medicaid, I think there is a real concern that we have. And, of course, the concern isn't just in the Medicaid market. The concern is also in the private market.

    So, what a lot of people don't realize is, before the Affordable Care Act, private health care plans didn't necessarily include maternity coverage as a requirement, as did employer-based plans or Medicaid.

    And so we have got to look at the totality of the health care system in making sure that all women, irrespective of them being in a private plan or Medicaid, have access to those resources they need. And we believe that much of the support that women need could be at risk. And that's what our primary concern is.


    How do you answer the argument from conservatives that, look, something has got to be done, that Medicaid has grown at a rate that's just out of control, cannot be sustained, and unless some methods are found to scale that back, Medicaid is not going to be there in the long term for people who need it?


    Well, we share that concern.

    Obviously, the costs of Medicaid are exorbitant and they're growing. But let's look at what's really going on in the Medicaid market. You have got a lot of low-income women, many women of color.

    And what we see are health outcomes not improving. One of the big concerns that we have at the March of Dimes is we just — the government just issued some statistics showing that pre-term birth rates have now increased for the second time in the past two years, after some decline over the past seven years.

    Health outcomes are not improving for pregnant mothers and babies. It's actually going down. And so, one of the things that we can do to control the costs of Medicaid and health care in general, again, is to focus on what all early interventions can be put in place, what prevention methods could be put in place to educate and inform and provide the support and the health care coverage that women need, so that both kind of health outcomes can be avoided.

    If we can avoid those health outcomes, then we can avoid the cost in the system, and then we can keep those costs under control, so that we have a much more manageable system over time.


    We have heard on occasion from Republicans the argument, why should men, especially single men, be required to buy — to have coverage that includes maternity and birth costs?


    Well, that argument just goes against what insurance is all about.

    We all buy insurance for things we — that may never happen to us. We all buy insurance for a lot of things, including health insurance for health outcomes that we may never suffer from.

    And the fact that women are responsible for child-bearing does not mean that they're responsible for creating the baby in the first place by themselves. It takes men and women together to create babies.

    And so we believe it's very important that the insurance market cover those things that are risks that each one of us individually may not experience, but they are risks and there are costs that are in the system that are important to make sure get covered.

    So I think it's really important to say, look, when we buy insurance, we buy it for a lot of things that we personally may not experience or be impacted by, but that's the point of having insurance and that's the point of having a larger pool of risk included in insurance, so that it reduces the cost for everyone to participate.


    Stacey Stewart, the president of the March of Dimes, and the debate goes on. Thank you.


    Thank you so much, Judy.

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