The Affordable Care Act and Baby-making

How will American society pay for births to mothers who cannot afford to have children?

The current health-care “system” (hah!) is inefficient. That’s like saying heating your house with candles in January is merely inefficient. First, there is no system, at least not “a” system. We have lots of insurance companies skimming profits off the top and lots of people who can’t afford insurance premiums going to hospitals. That’s because hospitals provide services paid for by federal, state and county governments, meaning taxpayers.

Since doctors and hospitals like income, they frequently order tests that may be only marginally appropriate and then collect insurance fees. For instance, Ellis’s urologist likes to have him take a prostate PSA blood test and then come into the office so the doc can tell Ellis that it looks fine. Ka-ching! He could tell Ellis the news over the phone and not charge for an office visit.

One of the biggest criticisms of the current non-system is that rather than encouraging good health and illness prevention, it encourages procedures and visits. Health-care costs have risen 100 percent in the last decade.


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For the approximately 17 million folks who cannot afford insurance at all, the Affordable Care Act will expand Medicaid coverage starting in 2014 at a cost to the federal government of about $116 billion per year.

The cost controls built into the legislation are theoretical and experimental. These controls are based on the premise that about 30 percent of health-care costs are wasteful. In light of that, the law empowers a panel of medical experts to recommend reimbursements cuts to doctors and hospitals. There is also provision for evaluation of the effectiveness of various types of care.

It’s common knowledge that prenatal women should see their doctors to monitor the health of both the  mother and embryo/fetus. But lots of pregnant women are very young and/or poor. This frequently means they depend on the generosity of the state to pay for their care. Add to that the cost of birth and postnatal care. And if the baby is not well . . . well, you get the idea.

 Unfortunately for many families, policies frequently exclude maternity care for anyone other than the policy holder and spouse. That means a child of an insured individual may have to foot the bill herself. For more details on this click to the PBS News Hour site.

 According to the March of Dimes, the average cost for uncomplicated maternity care including prenatal care, a routine delivery, and three months postpartum care was $10,652 in 2007.

Teenagers, the report noted, are less likely to get early prenatal care, more likely to smoke and less likely to gain enough weight during pregnancy. Thus, they’re more likely to deliver prematurely, resulting in more complications, including a higher incidence of low-birth-weight babies. The medical costs for such an infant is nearly 10 times higher than for a baby of normal weight, the report found ($32,325 vs. $3,325, citing March of Dimes data from 2009).

There are many politicians who are trying to kill Roe vs. Wade, making low-cost or free abortions difficult, if not impossible, to obtain for the poorest among us. That would mean additional government expenses for the care and feeding of many unwanted children brought to term.

So how does the Affordable Care Act fit into this proposition? Bear with us. The act requires that beginning in 2014 anyone not poor enough to qualify for Medicaid must pay for some kind of insurance policy of their choice (from a select list on what are called insurance exchanges) or opt out of buying insurance and pay one percent of their taxable income as a penalty, and live without insurance. Those who opt out would be in the position of paying their own medical costs or “freeloading” off the government when an urgent situation necessitates their going to a hospital emergency room.

There is a quote circulating all over the news media from a self-employed woman in Texas: “I could much more easily afford a dadgum penalty than be saddled month after month after month with this kind of premium.” The woman, Laurie Tirmenstein, would only have to pay $250 annually instead of paying $1,800 for an insurance policy. Good luck to her if one of her kids comes down with a traumatic illness.

One way or another, the burden of low-income people bearing infants at the expense of our healthcare programs is scary. Some will get lots of care at almost no expense. Others will get very poor care, leading to the hazards of producing at-risk babies.

Right now the economy is depressing the birthrate somewhat. But sooner or later that is likely to change . . . big time! If and when the economy recovers, low-cost health care could provide incentives for Americans to get back onto the birthrate bandwagon.

The question for us is, considering there are already enough of us, should we be creating a healthcare program that encourages people to procreate, who might not otherwise be able to afford pregnancy and postnatal care?

We would like to see some funds be made available to teach high-school students the benefits of waiting and acceptability of not having children at all.


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