We’ve barely scratched the surface of Gov. Kasich’s 6000-page hate letter to women. The new budget will make it much more difficult for pregnant women to enroll in Medicaid and access timely prenatal care. This will result in the actual death of actual babies.

The budget actually undermines all seven parts of the Ohio Department of Health plan to address infant mortality. I want to focus on the process of enrolling in Medicaid.

In Ohio, 40% of deliveries are covered by Medicaid. This ODH report from 20091 gives a lot of insight into the effects of Medicaid coverage, but these are the keys:

  • only 43% of Medicaid-enrolled mothers are enrolled at the time of conception
  • only 44% of Medicaid-enrolled mothers receive prenatal care in the first trimester
  • 34% of Medicaid-enrolled childbirths are still uninsured at the end of the first trimester

Medicaid’s labyrinthine enrollment process2 is the reason for these figures. The way that this worked for underinsured women earning less than $30,000 is:

  1. You discover that you’re pregnant
  2. You go in person to Job and Family Services (can’t call them, they don’t answer the phone)
  3. They tell you to have Planned Parenthood3 fax them the positive pregnancy test
  4. Planned Parenthood administers the pregnancy test and refers you to a prenatal provider
  5. The prenatal provider charges you cash for your treatments and faxes JFS the charges
  6. After 90 days, JFS enrolls you in Medicaid
  7. JFS reimburses you for the pregnancy test and prenatal treatments

The obvious problems here are 1) you probably have no money and 2) you want to save the little money that you have for your child. The majority of low-income mothers in Ohio are tripped up by this catch-22.

Gov. Ultrasound just made this a hell of a lot more Kafkaesque, because Ohio will no longer be sending you to Planned Parenthood. They’ll be paying for ads to send you to Crisis Pregnancy Centers, who have no medical personnel. So:

  1. You discover that you’re pregnant
  2. You go to JFS and see an ad for a CPC
  3. You go to the CPC and get a positive pregnancy test
  4. The CPC doesn’t refer you to anything4
  5. JFS rejects your application5 because the CPC pregnancy test wasn’t medically-administered
  6. You go to Planned Parenthood and pay cash for your pregnancy test and office visit
  7. Planned Parenthood refers you to a prenatal provider
  8. You start a new Medicaid application
  9. After another 90 days, your new application is approved

As you notice in this system, pregnant women are liable to pay cash for 6 months rather than 3. Even then, it’s only once they figure out that Planned Parenthood is the place to go that they can even get the ball rolling.

Pushing a third of Ohio’s mothers into third-trimester prenatal initiation is going to make the infant mortality rate skyrocket, at a time that Obamacare is improving perinatal health outcomes everywhere else in the country5.

I suppose that it never entered the right-wing echo chamber that Planned Parenthood is the point of entry to the health care system for all reproductive health care, including childbirth. Gov. Ultrasound certainly doesn’t seem to realize that family planning providers are where uninsured women initiate the prenatal process.

As per the norm, Ohio’s women will be the ones paying the price for Kasich’s ignorance.


1 Oh, those halcyon days when ODH cared about pregnancies beyond the point where the mother decides to continue one. Seriously, ODH isn’t publishing these reports anymore–but their Report on Induced Abortions always makes it out on schedule.

2 Medicaid expansion would have solved this problem completely, but that was stripped from the budget.

3 I’m using Planned Parenthood as shorthand because in Southwest Ohio it constitutes the bulk of Medicaid-enrollment-tests. Every other safety net provider in the region is likely to have a much longer wait time, and time is very much of the essence.

Other family-planning providers fill this role in other parts of the state–but they’ve also just lost their subsidies for pregnancy tests.

4 CPCs are there to convince you to have a baby. Once you’ve made up your mind, they stop caring. Unlike Planned Parenthood, they do not refer to prenatal providers.

5 To be fair, some county JFS offices will accept this pregnancy test. Regardless, the CPC won’t refer you to a prenatal provider who accepts Medicaid.

6 This is another way that Gov. Ultrasound is going to make our health care more expensive than California’s. High-risk pregnancies cost around $25,000, whereas low-risk ones cost around $7000. The Ohio budget will make the majority of Medicaid deliveries automatically high-risk.

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