Ethics vs. cost: MDs push for immigrant prenatal care

The state of California’s plans to stop providing all non-emergency prenatal care to undocumented women will increase costs and precipitate a greater emergency than the flood of women now in need of prenatal care, say officials at the San Francisco-based California chapter of the AMA.

"Physicians are caregivers first, and providing prenatal care to any unborn child is our ethical responsibility," says CMA President Jack E. McCleary, MD. "We must protect [children and mothers] from suffering and possibly death."

Except for several lawsuits that blocked the effort, the state of California had planned to stop all nonemergency prenatal care to undocumented women this month, arguing that such action is required by the federal welfare law. In response to the state’s argument, however, a group of undocumented women seeking prenatal care — along with the city and county of San Francisco — filed suit to stop the state Department of Health Services (DHS) from cutting off payments for prenatal care. CMA filed an amicus curiae brief in support of the women’s lawsuit.

CMA accuses DHS of abusing its rulemaking powers by filing with the Office of Administrative Law regarding emergency regulations to eliminate the coverage. CMA argued in a letter to the department that "no emergency exists that warrants promulgation of these regulations on an emergency basis."

In fact, it would make matters worse. "The State’s filing of emergency regulations to end prenatal care to illegal immigrants will actually create an emergency," McLeary said in his letter. "To the extent that prenatal care is not provided, there will be a dramatic increase in costs to deliver and treat these unnecessarily compromised infants."

CMA is focusing on cost-effectiveness, noting these cost trends:

• Inpatient hospital cost for the mother-baby pair with prenatal care averages $2,374, compared to $5,168 for those with no prenatal care.

• DHS estimates an annual savings to the state of $70 million. CMA argues that costs to cover emergency room labor and delivery will zoom to $210 million annually if prenatal care is dropped.