March 2002 • Volume 8 • Number 3 |
•Chapters lobby for change•
A pregnant mom came to the group family practice of Barry Sundland, M.D, in Aurora, Colo., a few years ago for prenatal care and delivered a healthy baby. Recently, the same mom lost insurance, became pregnant and didn't make it to the office for care. She ended up in the emergency room with a kidney infection and was hospitalized for three days.
"If she'd been seen in the office earlier, a simple urinalysis and a $10 prescription could have eliminated the three-day hospital stay," Sundland said at a hearing of the Colorado Senate Committee on Health, Environment, Children and Families Jan. 24.
He was illustrating the need for maternity care to be covered under Colorado's CHP+ program, the State Children's Health Insurance Program. Colorado already covers prenatal care under Medicaid. The new bill Sundland was backing would expand that coverage so families eligible for CHP+ could have maternity care, namely, families with incomes between 133 percent and 185 percent of the federal poverty level, adjusted for family size. The bill would authorize Colorado to seek an easily obtainable waiver from the federal government to cover maternity care under CHP+.
"If women don't get coverage and don't have good prenatal care, kids get a bad start," said Sundland.
During the hearing, senators asked pointed questions, such as, "You estimate the new coverage would cost $6.5 million in state funds, and federal matching funds would be twice that. How do we know the $6.5 million per year won't go up greatly after the program's in full swing?"
Sundland, the only physician in private practice to testify, is familiar with maternity care coverage from insurers such as Cigna, Aetna and PacifiCare. "In the private sector, physicians receive from $2,000 to $2,500 for global OB care," he said, referring to prenatal care, delivery and postpartum care for an uncomplicated pregnancy. "Physicians' payments have been stable over the past decade. Despite inflation, insurers have done a good job of not paying us more."
The expanded CHP+ would provide $300 per month for physician reimbursement per patient. "Since most pregnant women receive care over an eight-month span, that works out to about $2,400," said Sundland.
Coalition building may save the bill, even in a time of budget crunch. All testimony at the hearing favored the measure. Staff from the Colorado Department of Health Care Policy and Financing, for example, said the 500 most expensive Medicaid births over the past few years cost an average of $195,000 each.
The budget battle looms. After the hearing, Colorado AFP lobbyist Pat Steadman of Denver said, "We're having major shortfalls. Most Medicaid providers will have their fees frozen, and there's a bill to cut pharmacists' dispensing fees dramatically, for a savings of $32 million."
Steadman added, "The idea that we'd expand coverage but cut pharmacists' reimbursement is a hard pill for some legislators to swallow. It's a tough year to argue for the CHP+ maternity care, but that's what we're doing. We know prenatal care is cost-effective."
As for the patient Sundland told the senate committee about, she was supposed to return to Sundland's office for further care. That hasn't happened. "We tried to get hold of her and can't," said Sundland. "We probably won't see her again until she has another major health problem or goes into labor."
FP Report is published by the
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Copyright © 2002 by
American Academy of Family Physicians.