Health coverage:
Extend it to unborn children of immigrants

		Eye on the  Capitol  Kathy Markeland

The governor's biennial budget proposes to extend Medicaid prenatal care services to immigrant women who do not currently qualify for state/federal funded health care.

This is an idea that deserves to be included in the final state budget. It makes sense both in principle and in practice. It is also an idea that may be rejected because of misplaced fear, which may blind us to this opportunity to truly advance a "culture of life."

Governor's proposal

Under current law, an "unqualified" immigrant woman (one who is undocumented or who may have legal permanent residency but have had that status for less than five years) does not receive any Medicaid funded prenatal care services before the last month of pregnancy.

Currently she is only eligible for "emergency" medical assistance in the last month of her pregnancy, through delivery, and into 60 days postpartum.

The governor's proposal would take advantage of a federal law which permits states to extend prenatal care coverage to a pregnant immigrant woman throughout the full nine months of her pregnancy. The federal government extends this option to states in recognition of the fact that once born, these children are citizens and therefore can be eligible for Medicaid supported services.

Who are the immigrant women who would be served by such an extension of benefits? The majority of the immigrants who would benefit from this change are Hispanic. Over the last 20 years over 140,000 Hispanics have migrated to Wisconsin. Since 1980, the Hispanic presence in the state has grown from 1.3 percent of the population to roughly 3.8 percent (over 209,000 as of 2002).

'Ounce of prevention'

From a budgetary perspective, the extension of prenatal care is a good bet for Wisconsin. The Department of Health and Family Services estimates that increasing access to prenatal care for these women and their unborn children will result in a net savings to the state.

The savings can be attributed to improved birth outcomes. Of those in newborn intensive care, the infants who did not receive prenatal care are nearly four times as likely to be premature and three times as likely to be of low birth weight.

Simply put, by investing in the proper medical care for mothers and their children in utero, the state buys itself an ounce of prevention instead of a pound of care.

Affirming dignity

More important, extending care to these women is the right thing to do. Our Catholic social teaching calls us to respect the dignity of all human life, particularly that which is at the margins of society.

Immigrants, whether they are legal or not, are among the most vulnerable members of our human community. The U.S. bishops have urged society to recognize the complexity of immigration in our global community and reject condemnation of immigrants.

In Ecclesia in America, Pope John Paul II said that the ultimate antidote to illegal immigration is the elimination of global underdevelopment and that, in the meantime, the human rights of migrants, even in cases of nonlegal immigration, must be respected.

Extending these services to pregnant women also affirms the humanity of the unborn child. In essence, the federal government has allowed for the extension of these benefits to these mothers because their unborn children are citizens. Providing health care services to these unborn citizens is a great affirmation of our belief in the value of all human life from the moment of conception.

As Catholics, we are uniquely positioned to advocate for both the immigrant woman and the unborn child. Some may reject the immigrant as somehow less deserving of our care and concern. Others may reject the unborn child as less than a person.

Our tradition calls us to embrace them both.

Kathy Markeland is associate director for respect life and health care issues for the Wisconsin Catholic Conference.

Covering the uninsured:
Must be a constant effort

	Guest commentary  By Andy Heidt,  Co-Chair, Covering Kids and Families, Wis., and  Dr. Frank D. Byrne,  President, St. Marys Hospital Medical Center, Madison

Healthcare is one of the most important components to our quality of life. When people are sick, hurt, or just not as healthy as they could be, their productivity suffers, the economy suffers, and family well being suffers.

Charity care

Here in Madison, hospitals have made a strong commitment to serving the uninsured and underinsured through charity care programs. St. Marys Hospital and other area hospitals also work with patients and their families to help them know what financial assistance they qualify for and how to sign up for those programs.

For example, St. Marys has an affiliation with Madison-based ABC for Health to provide health care consumers with the information, advocacy tools, legal services, and expert support they need to navigate through the complex and confusing health care financing system.

Yet every year hospitals provide millions of dollars of care for which there is no reimbursement. While hospitals are doing what they can to subsidize this care, much of the cost is addressed somewhere else in the health care system, often in terms of rising premiums for health insurance.

Many uninsured

The United States has one of the most technologically advanced and high quality healthcare systems in the world. However, in order to truly access healthcare, you need health insurance, something 45 million Americans (15.6 percent of the U.S. population) don't have.

While Wisconsin continues to boast one of the lowest rates of uninsured in the country, at any one point in time in 2003 there were 323,000 people (six percent of the population) without health insurance.

Even here in Dane County there are significant numbers of uninsured children and adults. Low wage workers, single adults under 65 without children, people suffering from layoffs and plant closing as well as immigrants are among the largest group of uninsured people in our community.

In addition, there are great disparities - by age, race, and employment status - between who has health insurance and who doesn't. Younger adults, ages 18 to 44, were more likely (11 percent uninsured in 2003) to be uninsured than other age groups; 16 percent of Hispanics in Wisconsin were uninsured in 2003, compared to only three percent of non-Hispanic whites; 19 percent of poor and non-poor residents lacked insurance, compared to two percent of non-poor residents.

Accessing programs

One way to begin addressing the lack of health insurance among Wisconsinites is to ensure that those who are eligible for programs that already exist know about and get enrolled in those programs, namely Medicaid and BadgerCare.

An estimated 26,000 children who are uninsured in Wisconsin are eligible for BadgerCare or Medicaid. We must reach those children and their families and make certain that enrolling in these high-quality family healthcare programs is clear, simple, and encouraged.

Bold commitment

But even if we cover those we've committed to helping access health insurance, hundreds of thousands of our friends and neighbors will still fall through the cracks. The time for a bold commitment to adequate access to health care is long past due and is important for the entire country, not just those lacking health insurance.

The costs to the community associated with inaccessible health care are numerous and large. When the lack of health insurance causes people to avoid going to the doctor until they are severely injured or dangerously ill and ultimately go to the emergency room, the costs associated with that care are much higher and often not recouped by hospitals.

Instead those costs are passed along to consumers of private health insurance in the form of higher premiums, eroding the ability of individuals and businesses to afford those premiums. In less extreme cases, the costs of lost time at work and the effect of carrying illness to work and school are a drain on our entire community.

The Institute of Medicine estimates that the uninsured cost the U.S. economy $65 billion to $130 billion every year.

Local hospitals, despite an incredible commitment to serving the uninsured, have hundreds of thousands of dollars in uncollectible medical debt generated every year by uninsured and underinsured patients The costs of this care are addressed somewhere else in the health care system, often in terms of rising premiums for health insurance.

Even being insured is not always enough. Many people carry only catastrophic insurance. While this provides coverage for extreme medical emergencies, routine healthcare services must be paid out of pocket. Even for those with more comprehensive insurance, monthly premiums and co-pays for doctor visits and prescription drugs can add up to make healthcare unaffordable and inaccessible for many individuals.

Make national priority

Maybe this is a signal that we need to follow nearly every other industrialized nation and make accessible, affordable healthcare for all a national priority.

The first week in May is national Cover the Uninsured Week. In order to provide quality healthcare to our entire population and encourage productive, healthy communities, this campaign must be year round and at the center of our attention.

We know the myriad negative consequences of having such a large uninsured problem are chronic and on the edge of being a crisis. We know solutions exist. We know (or at least we should) that ensuring the health and well being of all residents is the right thing to do.

The only question that really remains is: When will we act? The time is now!

For more information about Covering Kids and Families go to the Web page at www.ckfwi.org or call 608-261-1455. For more information about Cover the Uninsured Week, go to www.covertheuninsuredweek.org