Tipping the Scales

Proper medical care during pregnancy cannot guarantee birth of a healthy baby, but it does tip the scales in favor of both mother and child. Because too many poor women do not receive such care, California must work harder on the scales.

Gov. George Deukmejian has proposed increasing the budget for maternal and child health services by $7.5 million to replace money lost in federal budget cuts. Important as this money is, it will just maintain existing services; more needs to be done.

The Legislature is working on finances for a 1984 bill to improve prenatal care for poor women under the Medi-Cal program. A demonstration program showed that proper prenatal care that includes nutrition counseling and other health education reduced by 34% the number of babies born weighing less than they should. For each $1 spent on such care, $1.70 is saved in intensive care for newborns.

Assemblyman Burt Margolin (D-Los Angeles), who sponsored the 1984 bill, wants the state to provide $800 per case for a program of prenatal care that goes well beyond the existing basic Medi-Cal obstetrics services by requiring more visits to the doctor and thus more monitoring. It’s a smart investment and deserves full support.

Some pregnant women who are on Medi-Cal can’t find doctors who will accept them as patients at all because of the low Medi-Cal rates. For example, a recent study by the National Health Law Program found that in 15 small counties with over 13,000 women eligible for Medi-Cal, no obstetricians participate in the program. In 11 larger counties, including Fresno and San Bernardino, so few participate that low-income women are effectively denied care; 23% of the women eligible for Medi-Cal live in those 11 counties.

The Department of Health Services is considering increasing the current payment for just basic obstetrical services from $518 to $650. That does not completely cover the cost of care, but the state may not be able to afford any greater increase this year. That increase should at least encourage more obstetricians to see Medi-Cal patients.

Efforts are under way to help some 40,000 uninsured women, the working poor and teen-agers who are at particular risk for problem pregnancies. These women earn too much to qualify for Medi-Cal but are not covered by any medical plans. For starters, the Legislature should enact AB 4241, sponsored by Assemblywoman Teresa Hughes (D-Los Angeles), to study the costs and savings of prenatal care for these women.

After years of progress, California is backsliding. In 1984, 32,000 infants were born to women who received no prenatal care or care only late in their pregnancies. Doctors cannot treat what they don’t know about. The state should take these important and thrifty steps to help mothers and their children.