As reported by Joseph, State Representative John Becker, a self-described Christian, is proposing to cut eligibility for childbirth benefits for Ohio women. 40% of Ohio childbirths are covered by Medicaid1.

The result of his proposal would be a large reduction in medically-supervised deliveries.

It will, however, lead to an increase in childbirths with no prenatal care, midwifery, or obstetrics. I call this the “Away in a Manger” plan; why is Ohio paying for women to stay at the inn, when there’s a perfectly good stable next door?

This isn’t just cruel; it’s also stupid. But it’s stupid in an enlightening way.

By and large our health care spending occurs when we go out of this world, and when we come into it. The average pregnancy costs $30,000, which absolutely can’t be borne by the consumer; a pregnancy must be insured. Medicaid is the insurer of last resort for pregnant women.

royal baby

Medicaid gets a double-whammy because it also covers the child. The later that a mother initiates prenatal care, the more likely that the child will have congenital health problems. These conditions will be covered, for 18 years, by Medicaid. In the sadly frequent event of infant mortality, Medicaid costs soar.

It’s in the state’s best fiscal interest to ensure that pregnant women initiate prenatal care as quickly as possible.

As luck would have it, providing more prenatal care will result in lower pregnancy costs, lower ongoing pediatric costs, and lower infant mortality. And pregnant women really want prenatal care!

This is a very easy problem to solve! In fact, a number of states are solving it by expanding Medicaid to cover non-pregnant women, so that should they become pregnant they won’t be hassled by in-person enrollment and can focus on bringing a healthy, happy baby into the world.

This is also why Medicaid expansion will result in much lower per capita Medicaid costs. Currently Medicaid covers adults with very high medical costs (people with disabilities, pregnant women, and new mothers). Adding a large-and-growing pool of people with low medical costs will, de facto, reduce per capita costs. It will also prevent people from the low-cost pool from becoming people in the high-cost pool!

Medicaid expansion really is a silver bullet on pregnancy costs. Yet this new brand of Republican Christianity, wherein helping people is a sin, says that it’s better to waste public money if it will make life harder on people who don’t get paid very much.

Oh, and Mr. Becker: pregnant women who can’t get insurance will most assuredly get an abortion.


1 Because of Obamacare, this number will drop. Not because of Free Abortion Wednesdays, but because all insurance plans will offer maternity benefits. Currently, no plans on the individual market cover pregnancy.

It’s very important that we keep these waiver programs–particularly maternity–until we have full insurance coverage. Obamacare isn’t expected to achieve universal coverage until 2019; in the meantime, uninsured women will still get pregnant.