Potential cuts to Medicaid threaten Kentucky’s mothers and their families | Opinion
On Feb. 25, the House passed a budget resolution that is the first step towards massive cuts to Medicaid, the largest public health insurance program for adults and children with low-income, seniors, pregnant women, and people with disabilities. In Kentucky, Medicaid pays for, on average, 45% of births and a large portion of prenatal, postpartum, and infant care.
Medicaid has been a lifeline for mothers and infants in our state, even as federal and state legislative efforts have eroded access to care and created barriers to well-being. We live in a society that does not adequately support new parents and their infants. Kentucky does not have guaranteed paid family leave for the birth of a child, meaning that many mothers go back to work within weeks, or even days, after their child is born. Parents may not have any time to bond with their newborn unless time is taken as unpaid leave, jeopardizing their family’s economic stability. Even then, Kentucky does not offer job protections for taking unpaid family leave, or unpaid leave for medical care during pregnancy. A family member of mine was fired from her job several years ago for taking “too much” unpaid time off to go to prenatal care appointments. Fortunately, she was covered by Kentucky Medicaid and had access to healthcare even after being fired from her job.
Families struggle to afford, or even find, high-quality childcare so they can return to work. Instead, some parents are forced to leave the workforce because childcare costs are more than their monthly income. Because, for many of us, healthcare is tied to our job, leaving the workforce can lead to a loss of healthcare coverage and even more economic instability, at a time when families in our communities need more support than ever. These failings of policy and the healthcare system underscore the need for Medicaid so that, in difficult times, the health of Kentucky’s mothers and babies are not compromised.
Cuts to Medicaid will not only affect individual healthcare but will also impact the overall healthcare system in the state, including the maternity care workforce. Kentucky is a state with low access to maternity care providers and many of our counties have no access to OB/GYNs or obstetric care during pregnancy, especially in rural areas. Later this year, I will be publishing results from a state-wide study that found that Kentucky’s abortion ban, which has no exceptions for the life of the mother and limits the ability of OB/GYNs in our state to care for women in an ethical and evidence-based manner, are deterring medical students from wanting to stay and practice here. Cuts to Medicaid, which already reimburses providers for less than the cost of providing care, will certainly be another blow to healthcare providers and hospitals, threatening decreased access to healthcare providers for all of us.
Given that Kentucky has one of the highest rates of maternal death in the country, among other poor outcomes like high rates of preterm birth, we cannot afford to cut Medicaid coverage in our state. Instead, to save money and improve outcomes, we should invest in preventive care, such as prenatal care, and in building systems of support in our communities for pregnant women, new parents, and their infants.
As a researcher who studies the healthcare system, I am aware of its high costs and low efficiency. I am also aware that our existing healthcare system does not work for all, or even most, of us. However, rushed cuts to Medicaid, without a clear plan for alternative solutions, is not the answer for reducing costs or improving our healthcare system. Instead, cuts to Medicaid will worsen access, outcomes, and increase costs for all of us. Politicians are framing Medicaid cuts as a fiscal responsibility but, for Kentucky’s mothers and infants, the stakes of losing Medicaid are high and can be a matter of life or death.
Melissa Eggen is an Assistant Professor at the University of Louisville School of Public Health and Information Sciences. Her research focuses on maternal and infant health, reproductive health, Medicaid, and health policy. She is a Kentucky native and lives in Louisville with her husband and two children.