[Congressional Record Volume 143, Number 105 (Wednesday, July 23, 1997)]
[Extensions of Remarks]
[Pages E1501-E1502]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  DENYING LEGAL IMMIGRANTS VALUABLE PRENATAL CARE SERVICES ISN'T EVEN 
                  PENNY WISE--IT'S JUST POUND FOOLISH

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Wednesday, July 23, 1997

  Mr. STARK. Mr. Speaker, today I rise to defend the rights of legal 
immigrants in our country. In particular, I would like to address the 
potential health care crisis that is threatening the well-being of our 
legal immigrants and our health care system.
  In the quest to shrink the Federal budget deficit, many government 
programs have been threatened. Many of my Republican colleagues would 
lead you to believe that eliminating funding for legal immigrant health 
care is a fiscally and morally responsible way of attacking the 
deficit. In the new welfare law, my colleagues have done just that, by 
leaving many health care funding decisions to state governors. As a 
result, health insurance programs that currently benefit legal 
immigrants, such as California's Medi-Cal Program, stand to lose 
funding when money-strapped states refuse to appropriate sufficient 
funds. Legal immigrant prenatal care is an example of an

[[Page E1502]]

essential government funded health care program that stands to suffer. 
Cutting spending by ignoring the health care of those folks is a 
perverse approach to reforming our Government.
  While the benefits of regular prenatal care are widely known, I would 
like to refresh the memories of some of my colleagues. Regular prenatal 
care helps to prevent birth outcomes that can be both physically and 
financially disastrous and distressing. Reductions in infant mortality, 
long-term disability, and infant and maternal illnesses have been 
demonstrated in numerous studies documenting the importance of prenatal 
care. Healthier mothers and babies lead happier lives, resulting in 
smaller health care costs in the long run.
  Legal immigrants deserve the same access to these essential prenatal 
care services as full citizens. We owe much of our country's 
development and success to legal immigrants. My ancestors and most of 
the ancestors of my colleagues and fellow citizens entered the country 
as immigrants. We need to acknowledge not only the contributions of 
past immigrants, but of current legal immigrants. Many legal immigrants 
today serve in our military and are hard-working taxpayers. They 
deserve basic health services in return for their contribution to 
society.
  If legal immigrants are denied access to such effective prenatal 
care, both the government and these immigrants rely on Medi-Cal for 
their medical coverage, many of which receive prenatal care. If 
California gains more independent leverage in funding Medi-Cal, as is 
proposed in the welfare law, innocent mothers and babies stand to be 
denied preventive care. Instead, they will crowd our hospitals and 
emergency rooms for avoidable crisis care as well as routine matters. 
The costs that our state will have to absorb will well offset any 
savings incurred through the welfare law. This process will be repeated 
throughout the country, leaving millions of legal immigrants and their 
states, in dire financial, not to mention public health, straits.
  I am baffled by why my Republican colleagues would want to encourage 
the demise of prenatal care programs for legal immigrants just as 
programs such as Medi-Cal have proven to work so well. According to the 
California Policy Seminar, Medi-Cal expansions during the 1990's have 
increased the percentage of pregnant women who received adequate care 
once they began prenatal care from 72 percent in 1990 to 85 percent in 
1995. Willfully halting the progress that has been made in prenatal 
care availability is irresponsible, immoral, and illogical. Instead of 
dismantling prenatal care programs for legal immigrants we should be 
focusing on improving the timeliness of care received by legal 
immigrant mothers. I appeal to my colleagues to consider these 
realities as we continue to debate budget expenditures.
  The attached summary of a California Policy Seminar study on prenatal 
care documents the need to maintain coverage for legal immigrant 
prenatal care services. An investment in important preventive health 
programs secures a healthy future for our country and the legal 
immigrants who will continue to be integral to our progress as a 
nation.

        [California Policy Seminar Brief Vol. 9 No. 2 June 1997]

                 Access to Maternity Care in California

(By Paula Braveman, Kristen Marchi, Susan Egerter, Michelle Pearl, Lisa 
                       Nelson, Michelle McDermid)


                     IMPLICATIONS FOR FUTURE POLICY

       This report presents findings from a study of 10,132 women 
     who gave birth in California during 1994-95, based on 
     previously unavailable data concerning characteristics of the 
     women delivering in the state, their income and insurance 
     status, their use of prenatal care, and barriers to care 
     remaining after Medi-Cal eligibility expansions. These 
     findings suggest several important considerations for policy 
     making and for the design of health care services to improve 
     birth outcomes in California.
        The majority of women who deliver in California 
     are low-income--a finding that needs to be reflected in the 
     design of perinatal health care delivery.
        The expanded prenatal coverage needs to be 
     maintained, not reduced. The expansions of Medi-Cal income 
     eligibility for pregnant women have been successful in 
     ensuring that virtually all (98%) pregnant women in 
     California during 1994-95 had health insurance coverage at 
     some time during their pregnancies. This represents 
     considerable progress since 1990, when only 89% of pregnant 
     women in California had prenatal insurance.\2\ Because 
     uninsured women are currently almost all income-eligible for 
     Medi-Cal, there does not appear to be a need to expand income 
     eligibility beyond 200% of the poverty level. However, 
     legislative efforts to eliminate Medi-Cal eligibility for 
     immigrants threaten to increase the number of low-income 
     women without coverage for prenatal care. While this study 
     did not obtain information on immigration status, it did find 
     that 28% of women with Medi-Cal coverage during pregnancy had 
     lived in the United States for five years or less. Thus, the 
     number of women who could remain uninsured during pregnancy, 
     either because they no longer qualify for Medi-Cal or because 
     they fear deportation if they enroll, is potentially high.
        The success of Medi-Cal income eligibility 
     expansions has been demonstrated by improvements both in the 
     provision of coverage to low-income women at some time during 
     their pregnancies, and in the proportion of women who receive 
     an adequate number of visits once they begin care. The 
     greatest remaining challenges are ensuring that low-income 
     women receive timely coverage and timely prenatal care.
        Timing of prenatal care initiation was related to 
     whether the pregnancy was planned or wanted. Continued 
     support for programs such as the State-only Medi-Cal family 
     planning program may help reduce unplanned or unwanted 
     pregnancies as well as contribute to timely prenatal care for 
     women who choose to become pregnant.
        The importance of pre-pregnancy care for improved 
     birth outcomes has been described by others.\6\ In current 
     study nearly half (49%) of women with Medi-Cal coverage 
     reported having no regular source of care before pregnancy, 
     and these women were 40% more likely to have had untimely 
     care than were women with a regular source of care, 
     controlling for other risk factors. Improvement in the number 
     of women with a pre-pregnancy source of health care could be 
     expected by providing all women with continuous insurance 
     coverage.

                          ____________________