Health care reform and looking down the road to the next reform

Am I excited about health care reform? Yes, although after all the back-and-forth and ups and downs, it ended by feeling a bit anticlimactic - stumbling across the finish line in a daze, just glad to have gotten here. Remember when Obama said he wanted it done by last August?

I am hugely frustrated, as many other people are, by ridiculous restrictions on abortion coverage. I'm also seriously disappointed by the lack of coverage for immigrants (and not just undocumented immigrants - there's a 5-year waiting period even for documented immigrants to get on Medicaid). And I just want to tell a little story.

The CenteringPregnancy group I'm co-facilitating right now is Spanish-speaking, so obviously most of the women are fairly recent immigrants from Latin America. The way Medicaid works, at least in this state, is that when you show up for your first prenatal visit you get two months of "presumptive eligibility". That means that Medicaid will let you get two months of care, and after that you have to prove that you're Medicaid eligible to continue to be covered. So the clinic tries to get as much done as possible before the two months is over. After that, you're paying out of pocket until you go into labor, at which time emergency Medicaid kicks in to cover the birth and a short period thereafter.

At last month's Centering visit, one of the participants got a call - during the visit - that her husband had been arrested and was about to be deported. At this month's visit, we found out that he was deported and that she was struggling to support her family. She was worried about having enough money for food for her other children. At the end of the group, she began to cry. And on top of this, she has to deal with the expenses for this pregnancy. She has an ultrasound scheduled but will have to decide whether to try to scrape together the money for it, or skip it altogether.

Worse, if she or any of the other women outside of their Medicaid eligibility need to be admitted to the hospital for some reason, like blood pressure monitoring, they'll end up with the bill from that too, and those bills are just insane. This is the reason we're getting health care reform, and yet we are making it impossible for a significant segment of the population to access.

Acting like undocumented immigrants are somehow leeches on taxpayer funds is a falsehood. Undocumented immigrants DO pay taxes. Many pay income taxes, and nearly all have payroll taxes taken out. And all of them pay sales taxes. They put a staggering amount of money into Social Security that they can currently never hope to see returned to them. Is all of this so terrible that they won't even be allowed to purchase insurance, again using their OWN money, on the insurance exchanges? God forbid they ever be able to receive Medicaid coverage for medical necessities.

And the thing that really gets me about all this is the fact that all of these pregnant, uninsured undocumented women? Their babies will be born American citizens. Medicaid will willingly, automatically cover those babies and any health problems they have (perhaps as a result of inadequate prenatal care?), for the rest of their lives. But we won't take care of their mothers, even during their pregnancies.

Obama says immigration reform is coming next; it can't come soon enough after this health care bill.