Preterm Birth in the United States by Janet M. Bronstein

Author:Janet M. Bronstein
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

As noted above, the final pregnancy expansion of Medicaid in April 1990 required states to cover all women with incomes up to 133 % of the Federal poverty level for maternity care services through 60 days post-delivery (Hill 1992). Shortly thereafter, advocates began pressing Congress for an additional expansion of publicly funded health insurance to cover uninsured children whose family incomes were too high to qualify for Medicaid benefits. The State Children’s Health Insurance Program (CHIP), enacted in 1997 under a Democratic president with a majority Republican Congress, provided federally funded grants to states to either expand their Medicaid program to cover more children, or to sponsor a separate insurance program open to low income children. States had flexibility to define the eligibility criteria and the structure of the programs.

The CHIP programs were immediately politically popular, and were successful in reducing the number of uninsured children (Ryan 2003). In the early 2000s, a coalition of Republican and Democratic members of Congress began to craft legislation designed to amend the statute to include pregnant women. The amendment was framed as providing children who would be covered by CHIP programs upon birth, the healthiest start in life, by covering prenatal care for their mothers. Maternal coverage would be structured, as in the Medicaid program, to include a 60 day postpartum period. Before the legislation was fully drafted, however, the Bush administration announced that the Department of Health and Human Services would pre-empt Congressional action by issuing rules deeming fetuses to be children for the purposes of CHIP coverage, thus allowing states to cover prenatal care through the federally financed CHIP program.

This action by the Administration was widely seen as an effort to establish a legal basis for eventually prohibiting abortions, on the basis that fetuses are not different from children already born. The CHIP reform was promoted in the political context of a set of pro-life activities, such as the Baby Doe legislation discussed above, that occurred early in the Bush Administration. Women’s health advocates expressed concern that expanding prenatal care through CHIP would mean that care needed by women during pregnancy or immediately after delivery would not be covered, because it would benefit mothers, but not fetuses.15 On the other hand, as the Administration pointed out, this mode of CHIP expansion would allow states to cover prenatal care costs for undocumented immigrants, because their fetuses, if born in the United States, would be U.S. citizens. Medicaid does not cover prenatal care for non-citizens (Dailard 2002). As of 2009, 15 states had employed the “unborn child” option to cover pregnant women under CHIP programs. Another 6 states had waivers approved to include comprehensive maternity benefits for women who were not U.S. citizens, but whose children would qualify for CHIP upon delivery (Parisi and Klein 2009).

The expansion of CHIP to include prenatal care illustrates again the capacity of the “saving babies” approach to support the passage of policies that would otherwise have powerful political opposition. In the case of the unborn child CHIP

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