As reported by The Hartford Courant, March 9, 2004.

Poor, Pregnant and Made to Pay

By James F.X. Egan

The health of Connecticut families is at risk.

Last year, the General Assembly passed a law requiring that the Department of Social Services ask the federal government for permission to charge premiums for pregnant women and children in Medicaid. No other state charges Medicaid premiums for these vulnerable populations. The Connecticut Health Foundation estimates that as many as 2,000 pregnant women will lose Medicaid coverage if premiums are implemented. We believe these changes should be repealed.

Medicaid is an essential service for low-income populations. In our state, Medicaid covers more than 25 percent of the 42,000 births each year. In the largest cities, most babies are born to Medicaid recipients, including 60 percent of the births in Hartford.

The imposition of premiums and co-payments for pregnant women, infants and children with extremely low incomes - some as low as $636 per month - will result in pregnant women delaying or forgoing prenatal care and children going without preventive care, only to incur greater costs later. Prenatal care is important for healthy birth outcomes. Women who receive prenatal care are more likely to have access to screening and diagnostic tests that can help identify problems early. They are also more likely to receive education, counseling and referrals to reduce such risky behaviors as smoking and poor nutrition. Lack of prenatal care is associated with poor birth outcomes, such as low birth weights or preterm births. Premature babies can suffer lifelong consequences, such as chronic lung disease, cerebral palsy, blindness and mental retardation.

The goal of prenatal care is to identify problems before they become serious for either mom or baby. All women need prenatal care. Young or old, first baby or fifth, all mothers-to-be benefit from regular care during their pregnancy.

Each week in Connecticut, approximately 80 babies are born at less than 37 weeks gestation, and that number is on the rise. Between 1991 and 2001, the rate of preterm infants born in Connecticut increased 5 percent. On average, 60 babies a week are born weighing less than 5.5 pounds. The financial burden for an average (24.7 days) hospital stay for a single premature baby is $75,000, compared to $1,300 for the average 1.9-day stay of a healthy full-term baby. Almost half of all hospital charges for infants in the United States are for those born too soon or too small. The emotional costs can't be calculated.

Although the March of Dimes recognizes the budget challenges faced by the Connecticut General Assembly in the current economy, the cuts to our most vulnerable citizens go too far. In the interest of the pregnant women, infants and children in the HUSKY and Medicaid programs, we ask for the repeal of these changes. Prenatal and pediatric care for the underserved is both good medicine and good policy.

James F.X. Egan, M.D., is vice chairman of the Department of Obstetrics and Gynecology at the University of Connecticut Health Center and premature-birth campaign chairman of the March of Dimes' Connecticut Chapter.