Rebecca Rayman described it simply: The change in Medicaid coverage for about 1,500 pregnant Nebraska women has drastically affected mothers, infants, doctors and medical clinics.
At Rayman's Good Neighbor Community Health Center in Columbus, four babies have died in utero, two in the final four weeks of pregnancy. In the previous six years, the clinic had not lost any unborn babies after five months gestation.
Until the Medicaid coverage change, no women getting prenatal care had ever inquired about abortion.
Andrea Skolkin, CEO of OneWorld Community Health Centers, said the full impact of the lost Medicaid coverage is just beginning to unfold.
One baby delivered at 20 weeks, whose mother did not have prenatal care, did not survive. The mother had come to the center fearful of going to the hospital, in case she was not in labor.
The center has had nine premature births to uninsured women, compared to five for those with insurance, she said.
While the health center used to see 85 percent of patients on Medicaid, they now see 9 percent on Medicaid and 66 percent uninsured, Skolkin said.
Moms can qualify for emergency delivery care, but it is a lengthy process, she said.
Rayman and others testified Friday at a Health and Human Services Committee interim hearing on the costs and effects to women and infants -- and the state -- of Medicaid not providing services to certain low-income women, including undocumented mothers, since March 1.
"I fear that in five to 10 years from now the state is going to have an ongoing expense it cannnot stop because of the decisions made," said Sen. Arnie Stuthman of Platte Center. "Children are going to be needing help for 20 years, and it's going to be an expense of the state."
Rayman, executive director of the Good Neighbor Community Health Center in Columbus, said that since the Medicaid change March 1 at her health center:
* The number of women seen per month has doubled, from 53 in January to 109 in October. Seven to nine pregnant women are calling each week for first-time prenatal appointments.
* In October, the clinic provided prenatal care to women from 13 counties, some of them driving as far as from 156 miles away. They say they cannot get care in their towns or counties without insurance and cannot afford to pay for it themselves.
* In 2007 and 2008, over 80 percent of patients entered prenatal care in the first trimester of pregnancy. In 2010, with Medicaid changes, 32 percent of women are being seen in the first trimester.
* The percentage of low-birth-weight babies has gone from 7.26 percent of all infants to 10 percent, with some months at 20 percent.
With the increase in prenatal patients, and the decrease in reimbursement from Medicaid, the clinic has had to shift away from mental health care. Rayman said the community has seen more mentally ill people getting in trouble and being arrested.
Dr. Paul Welch, an obstetrican-gynecologist in Columbus, said his practice is not getting reimbursed even for the emergency obstetric care it is providing, costing about $100,000, mostly because women are not able to fill out the paperwork properly.
Doctors also are facing increased exposure to malpractice because of the high-risk population they are treating.
Preventive care is the foundation of medicine, he said.
"And yet, inexplicably, the state of Nebraska has done just the opposite," he said. "And I believe that continuation along this course will result in a financial and human course that will make any short-term savings appear minor by comparison."
"It is mind boggling to me as a health care provider," he said.
John Cavanaugh, executive director of Building Bright Futures, said he had not heard one word of testimony on the positive impact of the Medicaid change in policy.
"This is very destructive in terms of consequences for the state of Nebraska," he said.
The Rev. Howard Dotson of Westminster Presbyterian Church in south Omaha came to the hearing to tell of his concern about women in his area considering abortion and the babies dying and suffering because of the loss of Medicaid coverage.
"Each life is sacred. And those four babies that we talked about in Columbus and the one baby in Omaha should break our hearts," he said. "These babies are innocent, and we're punishing them for the documentation status of their mothers."
Dotson said people need to stand up to the anti-immigration sentiment and racism in the state. These children are the casualties, he said.
Lincoln Sen. Kathy Campbell, who introduced the interim study resolution, said she and other senators who supported a bill in the last session to restore the coverage must gather more statistics on the effect of the loss of Medicaid for these women.
"Anecdotal information is important to the issue, but we need actual numbers" before any future legislation on the issue is introduced, she said.
Reach JoAnne Young at 402-473-7228 or firstname.lastname@example.org.