State: Senate panel proposes cuts in prenatal care

Joanne Campbell makes $120 a week cleaning rooms at a St. Petersburg psychiatric facility. She is 38 and six months pregnant. She cannot afford health insurance and earns too much to qualify for standard Medicaid, the state-financed insurance program for the poor.

[Times photo: Amber Tanille Woolfolk]
Joanne Campbell is 6 months pregnant and says she would be working three jobs to afford prenatal coverage if not for the state's Medicaid program.

But under a program the Florida Legislature expanded a decade ago to improve prenatal care for thousands of women on the brink of poverty, Medicaid covers her exams while she is pregnant.

"I could not have afforded the doctors' visits," said Campbell, who, because of her age, will have a checkup two to three times a month until she delivers. "I'd be working three jobs."

Proponents credit such coverage with helping to drive down Florida's infant mortality rate by 20 percent since 1991. But about 15,000 working poor women each year would be left without it under a cut proposed by the Senate Subcommittee on Health and Human Services.

The proposal is shaping up as one of the most controversial of the hundreds of reductions, large and small, being considered in health and social services as the governor and the Legislature seek to control Medicaid costs and make room for $313-million in tax cuts.

Currently, women who earn up to 185 percent of the federal poverty level -- that's $27,065 for a family of three -- can get Medicaid coverage for prenatal checkups.

Under the proposed change, the income limit would drop to 150 percent of the poverty level, or $21,945 for that family of three.

That would save the state $37.2-million. But advocates for pregnant woman say taxpayers would pay for it later by having to treat more children born with complications commonly associated with poor prenatal care, including low birth weight and poor neurological development.

"This directly targets the working poor. These are people who make too much money to get regular benefits, and the only way they qualify is when they're pregnant," said Carol Brady, president of the Florida Association of Healthy Start Coalitions and executive director of the Northeast Florida Healthy Start Coalition in Jacksonville. "It's a cheap investment for the state."

Added Ann Ashcraft, executive director of the Hillsborough County Healthy Start Coalition, "You cannot just save money by doing this. You may cut money from the budget, but you'll pay on the other end."

Medicaid for pregnant women who normally wouldn't qualify was part of the late Gov. Lawton Chiles' Healthy Start legislation in 1991. In addition to paying for doctor's visits, it established regional Healthy Start groups that provide a variety of care for moms-to-be and their newborn babies, from transportation to parenting classes to help quitting smoking.

Brady's association cites a Florida State University study that found every dollar spent on prenatal care saves $4 to $7 in post-birth care for health problems. And as the infant mortality rate in Florida has dropped to about 7 deaths per 1,000 live births, the percentage of women who get at least some prenatal care climbed from 74 percent in 1991 to 83 percent.

On Friday, members of the Health and Human Services subcommittee, a branch of the Senate Appropriations Committee, said they didn't like risking the Medicaid coverage when they made their proposed cuts. But while the governor is seeking health and human service cuts of $390-million, the committee suggested $440-million.

Many reductions are administrative or transfer government roles to private companies. Others include eliminating adult dental, visual and hearing services, for a savings of $43.2-million, and taking $115-million from the medically needy program, which last year spent $340-million on health care to 23,000 people.

Sen. Burt Saunders, R-Cape Coral, and Sen. Richard Mitchell, D-Jasper, said they hope to restore funding to the Medicaid program and others later, as the full House and Senate begin crafting the budget.

"It just doesn't make much sense to be moving forward with a tax cut when we're cutting services that are so important," Mitchell said.

Saunders said he agrees providing coverage for prenatal care saves money over time. "I'm worried about it, and a little paranoia is always good, but I am confident that we'll get more money and we will be able to restore some level of funding in most of these programs," Saunders said. "At least that's my hope."

Campbell, who lives at the Mustard Seed, a substance abuse rehabilitation center, said the Pinellas County Healthy Start and the Medicaid coverage have made the difference between a healthy, positive pregnancy and a disaster. If it weren't for the coverage, she couldn't afford to see a doctor, said Campbell, who until recently worked a second job.

"It wasn't, "Oh my God, I'm this poor pitiful woman,' " Campbell said. "I am a functioning member of society here. I have always worked all of my life, and I'm still working.

"This program isn't just for the down and out, this program helps all kinds of women in all kinds of situations."

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Lucy Morgan

From the Times state desk