Cuts to
Medicaid would further destabilize the already precarious healthcare system for
pregnant women and babies in rural areas and small towns, including those in
the Fredericksburg area.
According to
a new
report on Medicaid’s role in maternal and infant health in rural
communities, almost a quarter—24.5%—of Virginia women of childbearing age
living in such communities have Medicaid as their sole source of healthcare
coverage.
That’s greater
than the national average of 23.3%. Virginia is also one of nine states with
the biggest differentials in Medicaid coverage between women in rural and
metropolitan areas.
The report,
from the Center for Children and Families at Georgetown University’s McCourt
School of Public Policy, defines small towns/rural areas as “non-metropolitan
counties with central urban areas of fewer than 50,000 people,” using the U.S.
Census Bureau designation. Locally, that definition applies to Fredericksburg
City and Caroline and King George counties.
“Women in rural
areas already have difficulty accessing care because of the loss of labor
delivery units and obstetrical capacity,” said Joan Alker, one of the lead
authors on the report, in a webinar hosted Thursday by the Center for Children
and Families. “This is a real challenge for rural communities and particularly
in the face of very large cuts to Medicaid that Congress is contemplating right
now.”
Since 2010, the
percent of rural hospitals that do not offer obstetric care has been
increasing, said Katy Kozhimannil, co-director of the Rural Health Research
Center at the University of Minnesota, who participated in Thursday’s webinar.
“Between 2010
and 2022 there were 537 hospitals that lost their obstetrics programs,”
Kozhimannil said. “Our research shows that by 2022, 52.4% of rural hopsitals
did not offer obstetric care,” up from 43% in 2010.
According to a
March article in
Cardinal News, Virginia lost five labor and delivery units between 2018 to
2024, “due to the financial strain of maintaining these services.”
Obstetric care
has high fixed costs, “requiring dedicated space, equipment, and trained staff”
who must be constantly on-call, Kozhimannil said. “Revenues are variable and
depend on the volume of births, which disadvantages lower birth-volume
hospitals.”
Medicaid pays
for almost half of all births in rural areas and 40% of those in urban areas,
she continued, and it reimburses at a lower rate than private health care
plans, which disadvantages facilities in rural areas. Cuts to Medicaid would
make it even more difficult for facilities to stay open in these areas.
When a facility
closes, the effects are felt by everyone, not just those with Medicaid, said
Ryan Cross, vice president of government affairs and advocacy for Franciscan
Missionaries of Our Lady Health System, during Thursday’s webinar.
“It all comes
back to the Medicaid dollar,” Cross said. “Every dollar is critical, not for
market share, but to meet community need and save lives. When Medicaid is cut,
everyone is affected. That commercially insured patient will also have to drive
further if a hospital is closed.”
Access to
maternity care is crucial to reducing adverse outcomes such as maternal
mortality, stillbirth, preterm birth, and NICU admission, according to a recent
March of Dimes report.
According to
Edwin Park, a professor at Georgetown’s McCourt School of Public Policy, there
are proposed cuts to Medicaid spending of at least $625 billion in the budget
bill that was reported out of the House Energy and Commerce Committee on a
party line vote.
Preliminary
estimates from the Congressional Budget Office indicate that Medicaid
enrollment would fall by 10 million people, and 7.6 million people would become
uninsured, Park said.
The Medicaid
provisions in the budget bill include a mandatory work requirement, extended to
the age of 64, in all states.
“You would have
to satisfy the work requirement upon application, with states given the
flexibility to look back multiple months and potentially a year or more to see
if you could satisfy that work requirement or qualify for an exemption,” Park
said.
There’s also a
proposal requiring states to conduct redetermination of Medicaid eligibility
every six months, rather than once a year, and a provision that would prevent
states from implementing new provider taxes or increasing existing taxes.
“These are
taxes to raise revenues to finance the state’s share of the cost of the
Medicaid program,” Park said. “So no new taxes and no increases in taxes would
limit the ability of states to identify sufficient revenues to not only make
improvements to Medicaid over time, but also sustain existing Medicaid over the
long run.”
And there’s a
proposal to limit retroactive coverage, which is important for people who have
sudden longterm care needs, Park said.
Kozhimannil
said the impact cuts to Medicaid will have on care for pregnant women and
babies and access to facilities with labor and delivery services “cannot be
overstated.”
“Every person
is affected by the loss of birth in that community,” she said. “It changes how
a community sees itself.”
