Health Services for Low-Income Legal Immigrants: Scrimping Now will Cost Us All Later

As mentioned in a previous post, 78% of funding has been cut for an important Medicaid "add-on" program for legal immigrants-Marylanders who have been in the country less than five years and hold green cards. As reported in the news, this money is used to provide prenatal care to pregnant women and preventive care to their existing children through the Maryland Children's Health Insurance Program (newborns would be covered by Medicaid).

In FY 2005, the program's funding was approximately $7 million, and all of it was cut from the Governors FY2006 budget. However, the state's swelling budget surplus prompted the Ehrlich Administration to restore $1.5 million to the program.

What about the remaining $5.5 million? As with all policy choices, there will be both immediate and long-term implications for reducing the access to health care. These impacts are as follows:

• Increases in Maryland's uninsured population. As of July 1st, approximately 3,000 Marylanders-children under the age of 19 years-lost their health insurance coverage. Further, no new mothers are being accepted into the program, which means (assuming constant enrollment trends) approximately 1,000 newly pregnant women will lose access to health insurance.
  
  
• Declines in access to prenatal care. Disallowing prenatal care for pregnant mothers will likely worsen the health outcomes of their newborn children. It is estimated that every dollar of prenatal care results in savings of $3.33 for postnatal care and $4.63 in illness costs over the life of the child.1 The health care costs associated with prenatal care are lower than the costs of treating the outcomes from not getting the care. 2
  
  
• Increases in uncompensated care for Maryland's health care providers. The health needs of newly pregnant women and children will not dissipate because the funding for health services has been reduced. One of the more likely outcomes of this policy change is a marked increase in uncompensated care for hospitals physicians and other health care providers. In turn, these health care providers will pass on the costs of un-reimbursed care to Marylanders through higher prices and increased insurance premiums.

Certainly, the short run costs of restoring the program are much more cost effective than the consequences of not doing so, when calculating the financial and human cost incurred of the immediate increase in Maryland's uninsured population, the health consequences of the decline in access to prenatal care, and the potential increase in uncompensated care for Maryland's health care providers.

1. National Committee for Quality Assurance, "The State of Health Care Quality 2004: Prenatal and Postpartum Care (Timeliness of Prenatal Car e, Checkups After Delivery)", Available from www.ncqa.org.

2. R.D. Gorsky & J.P. Colby, Jr., "The Cost Effectiveness of Prenatal Care in Reducing Low birth Weight in New Hampshire, Health Services Research, Vol. 24(5), p. 583-98, December 1989.