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Generation at Stake

December 27, 1987

Too many American children start life without one of its most precious gifts: good health. Too often women do not get adequate care before their babies are born--often because they have little or no maternity health insurance. A compassionate and forward-looking federal government would be working to correct the problem.

The Southern California Child Health Network has already documented the problems facing pregnant women in the state. It has shown the possible savings, financial as well as emotional, that come with good prenatal care. For example, the federal Office of Technology Assessment now estimates that the average hospitalization cost for newborns who must be kept in intensive-care wards ranges from $31,000 to $71,000. Proper prenatal care costs less than $2,000.

The Alan Guttmacher Institute, a research organization that focuses on population and health questions, reports that one in every four American women--that's 14.6 million women--in her childbearing years is without private or public maternity-care insurance coverage. Most have no insurance at all, and some have private health insurance that doesn't cover maternity care. Of the 3.7 million women who give birth each year, 555,000 are not covered by insurance that pays the costs of delivery in a hospital. With no money to pay the bills, many women put off all but the most urgent care--to the possible detriment of the children that they carry.

Many people fall through holes in the health-insurance net. That is especially true of pregnant women because they tend to be young, to work in low-paying, entry-level jobs with few benefits or to be part-time workers with no fringe benefits. Many work in service industries that often provide few health-insurance benefits.

To try to discover solutions to these problems, the institute surveyed Blue Cross/Blue Shield plans, commercial insurance companies, heads of Medicaid agencies, directors of community health centers, and state maternal and child-health directors. The conclusion: The patchwork system that now exists doesn't work.

The institute recommended that all private policies be required to include coverage for maternity care that would pay for all physician and hospital services. It also urged expanding eligibility for the Medicaid program so that more women are covered. States also need to pay more for prenatal care. California's level of reimbursement is so low that many doctors won't accept these patients. Nationally, only 4 of 10 doctors will accept them.

The federal government should also require states to process Medicaid applications from pregnant women more quickly, or give them incentives to do so, the Guttmacher report recommended. Prenatal care won't wait.

But not all of these changes are likely to be made at the federal level, let alone to be implemented by all states uniformly. For that reason the institute said that a uniform nationwide health-insurance system would provide a better answer "if the goal is to make certain that all women of reproductive age and their families have insurance coverage for at least basic prenatal, maternity and infant care." It is yet another good argument for this basic restructuring of health insurance. The well-being of the next generation is at stake.

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