March 2000 • Volume 6 • Number 3
• Grassroots Advocacy •
Carolyn Shepherd, M.D., testifies to a Colorado committee.Colorado AFP fights for prenatal coverage for all pregnant women
BY JANE STOEVER
If the Colorado AFP has its way, Colorado may be the first state to fund prenatal care for its undocumented residents. Two FPs made their case for the coverage Jan. 24, testifying before the Colorado House of Representatives Committee on Health, Environment, Welfare and Institutions.
Currently, the state's Medicaid program pays physicians and hospitals for labor and delivery services but does not cover prenatal care. The bill's specifics and the role of FPs supporting it illustrate advocacy in the legislative arena, a hot spot only too familiar to most AAFP chapters.
"The prenatal care problem has two parts," says Carolyn Shepherd, M.D., who testified on behalf of the CAFP. "First, there's the cost of providing a high level of service to all pregnant women. But if that care isn't provided, then there's the cost to the babies who are born premature because their mothers had no prenatal care. The babies might be blind; they might have developmental abnormalities; they may never go to normal schools. For the babies and their mothers, these issues can last a lifetime."
Shepherd, medical director of Clinica Campesina in Lafayette, told committee members the Lafayette and Thornton clinics provide care to pregnant women whether they're insured or not. "Our two clinics together give about $200,000 worth of uncompensated prenatal care each year," she says. "But Clinica can't provide care to everyone."
Virgilio Licona, M.D., right, strategizes with Jesse Thomas of Colorado Access during a committee hearing.The bill the committee considered would funnel Medicaid funds for prenatal care to a managed care organization. For budget neutrality, physicians now providing free care would be paid; hospital payments for labor and delivery would shrink.
CAFP President-elect Virgilio Licona, M.D., of Denver testified to the committee on behalf of Colorado Access, a not-for-profit, safety-net health plan that will bid for the Medicaid HMO contract if the bill is passed. Colorado Access is owned by the Denver Health Authority (the public health department), Children's Hospital in Denver, the University of Colorado Hospital in Denver, and Colorado Community Health Network, composed of 10 migrant and community health centers.
"The full Medicaid coverage for prenatal care should be provided," Licona says, even though the state's Medicaid department is concerned the HMO would be assuming high financial risks. "Our HMO is prepared to assume the risks," says Licona.
Leaders of the Colorado Health and Hospital Association are not impressed; they oppose the bill.
"If the bill passes, you're going to take a chunk out of Medicaid funds for prenatal care, take a chunk out for managed care administration, and then the MCOs will sit down and negotiate different payment rates with hospitals. All that adds up: The payments to hospitals are going to be less," says Larry Wall, president of the hospital association.
Licona suggests the current Medicaid payment for hospital labor and delivery services for an unauthorized patient is about $1,750 above market rates -- a difference sufficient to cover prenatal services.
The committee passed the bill 10-4, forwarding it to the House Appropriations Committee. The bill is likely to come before the full house this spring and move to the Senate, where the hospital association may fight it full force.
The association will have to tangle with the CAFP, pediatricians, OB-Gyns, social service groups and the Colorado Medical Society.
Shepherd sees defending the bill as part of family practice. "You have to work wherever the decisions are being made," she says. "Sometimes it's in the clinic, sometimes in the health department or legislature. The work is ours to do."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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