Bankrupt for Baby
Wednesday, February 06, 2008
By Grace Hammond
Jackson Hole, Wyo.- River Osborn rests her elbows on a table at Shades Café. The tips of her ears are pink as erasers; her posture straight as a sharpened pencil. She blows into her hands to warm them up. The air is soaked with the smell of scones and just-baked chocolate chip muffins.
River has a bun in the oven.
Her pregnancy is 14 weeks along. It was “a welcome surprise,” she says, but she’s still not sure what to do.
River, 26, has spent the last two years on Jackson’s science and research circuit as a seasonal parks employee. She has a B.S. in Ecology, which helped her secure her first position as a Habitat Biologist Technician for the Wyoming Game and Fish Department. That’s where she met her boyfriend of 15 months, Charlie, a Fisheries Biologist at the time.
When she learned she was pregnant, River withdrew her name from the running for a position with benefits at Grand Teton National Park, where she had just completed a season as a Fire Effects Monitor and Wildland Firefighter.
“Being a firefighter and a mother seemed incompatible - just for me,” she says.
River began looking for entry-level positions with benefits “all over town.” She and Charlie were between seasons and on unemployment. Together, they applied for Medicaid.
“We figured, gosh, we’re a shoo-in,” she says.
For a family of three - River, Charlie and their unborn baby - the income cap for eligibility was $1,900 per month. Theirs totaled $1,922. The family was denied.
River has yet to receive any prenatal care. The OB/GYN wants a “down payment of $1,000 just to start care with them,” she says.
Ideally, River would opt to receive her care from a midwife, but midwifery - more affordable than hospital birth - is illegal in Wyoming.
Without insurance, any hospitalization during pregnancy “would mean bankruptcy for me,” she says. “That’s not really an option.”
What remains an option is leaving the state. River and Charlie want to move to Oregon. “If you’re pregnant, you’re covered on day one,” River says. There, midwifery isn’t just legal; it’s covered by the state health plan.
“I feel really let down by Wyoming,” River says. “You know how you’re supposed to have joy during pregnancy? I feel like that’s been hijacked from me. Stress levels like this can’t be good for the baby.”
STANDARD AND SURPRISE COSTS
“The bottom line is that it costs a lot of money to have a baby,” said Bonnie Pockat at the Teton County Public Health Department. Even prenatal care doesn’t come cheap. Pockat explained the “down payment” system:
“Local OB/GYN practices rely on ‘global fees,’” Pockat said. “You pay up front - usually a few thousand dollars - and it counts toward care throughout the pregnancy and perhaps part of the delivery, like the obstetrics fee.”
There are many “parts” of delivery to cover. Even the most routine birth involves a bundle of fees - for the doctor, the hospital stay, an anesthesiologist (in the case of an epidural) and care of both mother and newborn, said Dawn Sheue, an agent at Summit Insurance.
At St. John’s Medical Center, charges for vaginal deliveries range from approximately $5,000-$6,800 and approximately $12,900 for a cesarean section (fees for newborn and mother included), said Karen Connelly, director of marketing and community relations. Insured and uninsured patients are charged the same rates by law. The hospital accepts Medicaid and offers some “charity care” to eligible women.
These fees are nothing compared to a “million dollar baby” - a preemie or a pregnancy with complications.
MATERNITY BENEFITS ‘SYSTEMATICALLY ELIMINATED’
In 2005, the most recent year for which data is complete, about two in three births in Teton County were to married women. The majority of mothers - 63 percent - were between the ages of 20 and 29.
Members of this age group are twice as likely to be uninsured as other state residents. Roughly one in three, or 31.1 percent, of Wyoming residents aged 19 to 29 lack health insurance, compared to about 15 percent of residents overall, according to state figures.
Since 2001, Wyoming has hovered near the top 10 states with high numbers of uninsured. This doesn’t mean people aren’t working; nationally, about half of the uninsured work fulltime. A 2003 Families USA study found that 88 percent of uninsured Wyoming families included a part- or full-time worker.
Wyoming residents without health benefits through an employer have three choices. Some are eligible for Medicaid or other state benefits. The poor but ineligible (or unconcerned) remain uninsured. And some purchase independent policies to protect themselves and their families. In 2005, Wyoming health care premiums cost an estimated $4,531 per individual and $11,841 per family.
Many women who purchase their own health care, however, are in for a nasty surprise when the stork arrives.
In the past three to four years, most maternity benefits have been systematically eliminated from independent health insurance policies, Sheue said.
“They don’t want to cover it. The smart insurer doesn’t,” she said. “Pregnant women come to my office in tears and I have to tell them they can’t get coverage. It is the hardest conversation I can have other than a death claim.”
Sheue emphasized that times have changed. “These are not the insurance policies your mother had,” she said. “Even the ones from five years ago are gone. Employers who don’t provide maternity benefits need to understand - so do the self-employed and people in transitions. There’s no longer any individual plan that will cover a pregnancy without you investing in it in premiums for a long period of time first.”
The few independent policies that offer maternity coverage now enforce waiting periods of 10-18 months before it kicks in, Sheue said. Premiums will be hiked, on average, an additional $300 to $400 per month for the duration of the policy, she explained.
“By the time you include the inflated premium, which you paid into every month for a year or year-and-a-half before you could even use it, you’ve virtually self-funded the delivery,” Sheue said. “They’re not paying anything. It was all your money.”
PREGNANCY AS A ‘PRE-EXISTING CONDITION’
Working women without workplace benefits make statistically low wages as they are typically in the service industry or working for small employers. For women in these sectors, simply purchasing their own benefits at 20 to 50 percent of their monthly income - a recent Wyoming estimate - is difficult enough. Doubling or tripling that monthly cost to procure future maternity coverage is unrealistic, if not impossible, for most.
Further, this requires planning and budgeting for pregnancy well in advance. Many (if not most) of Wyoming’s pregnancies are unplanned. In 2003, state data found that 49.1 percent of Wyoming women who gave birth were not trying to get pregnant when they conceived. Because this figure excludes women who terminated their pregnancies, it almost certainly underestimates the number of unplanned pregnancies that occurred that year.
There are no independent policies in Wyoming that can be purchased to cover a pregnancy that already exists. All will exclude it as a “pre-existing condition.” Even the Wyoming Health Insurance Pool (WHIP), the state insurance program of last resort, denies coverage to existing pregnancies. After paying into the policy for 12 months, however, maternity can be covered “as any illness,” the brochure states.
EMPLOYER-PROVIDED OPTIONS
Group policies with broad maternity benefits are the best - and perhaps only - option for local women who want children but are ineligible for Medicaid, said Sheue.
Group policies are provided by employers. Pregnancy cannot be excluded as a pre-existing condition in a group policy that covers it, Sheue explained. “Even if you’re eight months pregnant, if you can find somebody to hire you, you’re covered. This is the best news I have.”
Not all group plans are created equal, however. Employers choose the level of maternity coverage to offer when they set up the plan. Some cover complicated or uncomplicated pregnancies, but not both; others cover labor but not prenatal care; some don’t cover pregnancy at all. (For its part, the baby itself will be covered after birth if it is added to a group plan.)
Either way, without Medicaid, a sky-high independent policy premium or a good group plan, “you are going to end up self-funding that birth, and you’d better pray it’s normal,” Sheue said.
PRENATAL OPTIONS SHRINK
For many local pregnant women, the Medicaid process begins with an application at Public Health. There, women can be awarded “presumptive eligibility” for a period up to two months, which covers their prenatal care while they wait for the Department of Family Services to rule on full eligibility, Pockat said.
Beginning April 1, however, presumptive eligibility will no longer be available to non-citizens, nor will its two months of prenatal care, when new immigration laws take effect.
“There’s a lot of concern about this in our office and in other departments,” Pockat said. “We’re looking for new solutions. Otherwise, these women will basically not have any help throughout their pregnancy. They can go over to DFS and apply for what’s called emergency medical aid, which could cover the cost of labor and delivery, but not any prenatal care.”
This could exacerbate an existing problem. In 2005, nearly one in three Teton County women to give birth received “less than adequate” prenatal care, per state definitions.
“The instance of a woman without health insurance having quality prenatal care is somewhat limited based on cost,” said Sheue. “The outcome lends itself to a baby being born at a low weight and with problems.”
INELIGIBLE BUT UNINSURED
As these laws and insurance policies change, women in Teton County increasingly find themselves uninsured (or insured by a policy that excludes maternity) yet ineligible for state benefits.
Pockat advised women deemed ineligible for Medicaid to reapply if their financial situation changes. “[A woman] might not be eligible in December but she could be in January,” she said. “Unfortunately, beyond that, [she will] have to work with a doctor’s office to set up payments. There is nothing else out there.”
Teton County is an ugly place to apply for Medicaid. Eligibility is determined by a flat, statewide income cap. If your income is less, you are eligible. If it is more, you are not. Cost of living is not considered.
“The wage scale hurts people here,” said John Hudson, the county manager for the Teton County Department of Family Services. “What do they pay at the Loaf n’ Jug? You see those wages in the paper - $12 an hour. Service jobs pay much less in other counties, but that money goes further.”
There’s one wrinkle: Eligibility for Medicaid currently relies on “self-declaration,” Hudson said. “For now, we don’t seek out proof of income unless we have a real, valid reason.”
LIMITED ACCESS
In 2005, more than one in five of all American pregnancies ended in abortion, yet only 70 were reported in Wyoming.
This, too, boils down to an access issue. A Wyoming woman that has decided to terminate a pregnancy will find that there is a single advertised abortion provider in the state - Dr. Brent Blue at EmergACare in Jackson Hole.
“There are essentially zero options,” said Dr. Blue. “Either come to us or go to Salt Lake, Bozeman, or Ft. Collins.”
Dr. Blue’s office, which operates on an outpatient basis, provides only surgical terminations (not medical) and only through the 12th week of pregnancy.
Many Wyoming women opt to travel out-of-state for the procedure, said Sharon Breitweiser, Executive Director of NARAL Pro-Choice Wyoming.
Dr. Blue sometimes refers pregnant women who do not want abortions to the former “Crisis Pregnancy Center of Jackson Hole,” now called “Turning Point Pregnancy Resource Center.”
Their offices make strange bedfellows; Crisis Pregnancy Centers (increasingly called Pregnancy Resource Centers) are traditionally anti-abortion.
“[Turning Point] will help with some expenses, maybe room and board or adoption referrals, and we want everybody to know these alternatives. But they do lie to people,” said Dr. Blue.
Not so, said Blythe Cox, Turning Point’s new Executive Director. “Primarily what we’re here to do is offer peer counseling on all options of pregnancy.”
The center provides financial assistance on a case-by-case basis and may help a pregnant woman purchase a car seat, for example, or see a doctor.
“We are faith-based,” Cox said. “That’s one reason why we don’t refer for abortion. But we try to stay out of the political arena.”
Their intake form is clear: “The Pregnancy Center does not perform nor refer for abortion.”
This year, Jackson Hole’s center is working to “go medical,” Cox said, “and provide limited first trimester ultrasounds. Our purpose is to provide more insight for the woman. But,” she clarified, “We are not a medical facility. We do not have medical staff.”
Breitweiser said pregnant women are easily misled when crisis pregnancy centers offer ultrasounds.
“They exist, both the ultrasounds and the centers, just to dissuade women from procuring abortions. That’s it. Services like ultrasounds should not be confused with free prenatal care,” she said.
NOT ENOUGH
River and I couldn’t find Turning Point at its new location. We stopped at a shop to ask for directions. A middle-aged man straightened up from behind a pile of rugs in hot red and warm orange hues.
“Are you pregnant?” He asked, clasping his hands together.
“I am,” River said, and he beamed. “Good for you!” He pointed us the right direction. As we left, he shouted: “I think you’re having twins!”
River, still in her first trimester and dwarfed by a winter coat, shook her head.
The center ultimately offered River some assistance with her OB/GYN deposit - the case-by-case funding Cox described.
Still, River wasn’t sure. Oh, she was positive she was having the baby; just not so sure about staying in Wyoming, even with their assistance.
“It isn’t enough,” River said as we walked through the snow. Wyoming just doesn’t have enough services. Public Health was a bust, she said; Medicaid fell through. And for all her job applications, employers weren’t biting.
“Again, no real options,” River said. “What do you do?” She raised a hand to the wintry sky before answering her own question:
“Move to Oregon, I guess.”
Courtesy photoCharlie and River are going strong.PERMALINK:
Bankrupt for Baby | Planet JH News Article: Cover Stories
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