Insurance program stirs debate
The Oakland Press
Aug 13, 2006
NATALIE LOMBARDO Insurance program stirs debate
Now that her son is 2 months old, Christine's Medicaid will be terminated. As a full-time diagnostic ultrasound student, 36-year-old Christine - who wants to keep her last name anonymous - doesn't desire more children. However, the potential for a surprise pregnancy is a reality for her, as doctor visits and birth control will put a dent in her budget. "I can't tell you how long I've skipped going to the gynecologist, being a student without any health insurance," said Christine, of Waterford Township. But she could be helped by a program that aims to prevent unwanted pregnancies by providing reproductive health care such as contraception to more low-income women in Michigan. Plan First!, rolled out by Gov. Jennifer Granholm in early July, provides Medicaid to a wider pool of people - up to 200,000 more women - who would not otherwise have medical coverage. "We want to make sure every child in Michigan is a wanted child and a planned child," said T.J. Bucholz, spokesman for the state's Department of Community Health. But some say Plan First! is simply a Band-Aid for a moral problem. "The chemical approach to a social problem doesn't work. You have to grapple with the meaning of human sexuality. Until you do that, we'll continue to see out-of-wedlock pregnancies and feed the abortion monster," said Monica Migliorino Miller, director of Citizens for a Pro Life Society in South Lyon. Plan First! does not include abortion and fertility treatments. A survey of maternal experiences and behavior before and during a woman's pregnancy by the Michigan Department of Community Health showed that in 2001, about 41 percent of all pregnancies were unintended. Plan First! family planning resources include: annual physical examinations, followup visits, contraceptives, supplies and devices for preventing pregnancies, lab testing, counseling and education, treatment of sexually-transmitted diseases as well as male and female sterilization. The services are available to women ages 19-44 - who are at or below 185 percent poverty level - meaning a single individual who makes $17,700 or less per year or a family of four that brings in $38,700 or less. "There's a high correlation between poverty and childbirth," said Sandra Reese, president and CEO of Detroitbased Planned Parenthood of Southeast Michigan. "Providing access to these services allows women to better control when to become pregnant. They will be prepared and can take better care of the child. "It's a rippling effect that will reduce infant mortality, unwanted and abused children that are placed in foster homes or children that live in an uncomfortable environment because parents don't have the means to care for them properly," she said. Plan First! would reduce unemployment because mothers wouldn't have to quit working to raise children and collect welfare, Bucholz and Reese said. Women can enroll in the program by phone or online and a packet is sent via mail with information on where to obtain services in the respective area. Christine is considering enrollment. "It's an option available to where termination and poverty aren't the only two finalities. And it won't impact my day-to-day finances," she said. Planned Parenthood centers and private/public obstetrics and gynecology practices are the primary providers in Oakland County. People can seek help from other Medicaid-approved providers such as certified nurse midwives and nurse practitioners, too. Planned Parenthood is a nonprofit organization, with 30 health centers in the state, that offers reproductive health care to low-income, uninsured or underage people. The Michigan Department of Community Health reimburses the providers for services. Money saved Local women must use these providers for free reproductive health care because the Oakland County Health Division stopped delivering it in 2005, because of the lack of state funding, division Manager George Miller said. Granholm said if Michigan can reduce the number of "unintended pregnancies" by only 10 percent, it would save more than $27 million in Medicaid expenditures annually, as births cost $11,000 and contraceptives can cost more than $300 a year. And each public dollar spent to provide family planning services saves $3 that would otherwise be spent in Medicaid costs for pregnancyrelated care and medical care for newborns, added Janet Olszewski, director of the state's Department of Community Health. Still, the state is forking out $200 million to expand the Medicaid services, Bucholz said. Although Plan First! is a pilot program, the Medicaid waivers are good for three years and can be renewed. The continuous Medicaid coverage is the key to preventing the unwanted pregnancies, said Renee Horton, a medical assistant at Waterford Ob/Gyn, an affiliate of North Oakland Medical Centers. "The question the vast majority of my patients ask as soon as they deliver (a baby) is, 'When can I get on birth control?' " Horton said. "The problem is, they lose their Medicaid after they deliver, so then they end up back here pregnant again. Being more careful doesn't always work out." Migliorino Miller referred to Plan First! as a "treadmill," in which contraception, promiscuity and abortion are an endless cycle. "If the governor thinks this is a solution, than she's very wrong," Migliorino Miller said. There are a growing number of people who are unemployed or employed at a low level with a limited discretionary income, Reese added. "Unless they are chronically ill, they just don't seek out reproductive health care." Horton predicts that once more people know about the program, her patients will be jumping at the opportunity for free reproductive health care. Because of strict privacy policies, The Oakland Press was unable to speak with any local Plan First! recipients. Eighteen other states have similar programs. Differing views Migliorino Miller, who has counseled women in crisis pregnancies for more than 28 years, said distributing more contraceptives is not the answer. "Contraception, vasectomies and sterilization fail to appreciate the nature of sexual morality. Sex should be connected to commitment, responsibility and marriage," she said. "What we're doing is funding promiscuity with taxpayers' money." Pamela Sherstad, spokeswoman for Grand Rapidsbased Right to Life of Michigan, said Plan First! is sending a "mixed message." "There is a reality that, even when women are involved with family planning, unplanned pregnancies happen. A number of those happen when women are on birth control or using different methods. "And when you have a governor who is outspoken and connected with radical proabortion groups like Emily's List and Planned Parenthood, that sends the wrong message to young women." To stop unwanted pregnancies, Migliorino Miller suggests social programs for young people - that promote chastity and the responsibility of men to care for their children - provided by schools and churches. "It's an issue we will always need to deal with as a society - we're going to have unplanned pregnancies and how are we going to respond?" asked Sherstad. Reese argues Plan First! enables responsible behavior. "Not only are you going to get the care and information in reference to contraceptive options, but you're going to be counseled, and we assist so that women make better decisions," she said. "It promotes quality of life."
| 
