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Twenty-five years ago, the Texas Legislature passed a series of sweeping reforms to resurrect the state’s crumbling rural health care system.
Today, health care providers, advocates and local leaders are proposing equally aggressive measures to bring the rural maternity care system back from the brink. The Texas Rural Maternal Health Rescue Plan is a package of proposals that lawmakers hope lawmakers will champion this upcoming session.
Nearly half of Texas counties offer no maternity care services, and more than a quarter of rural mothers live more than 30 minutes from the nearest provider. Living in a “maternity care desert” contributes to delayed prenatal care, increased pregnancy complications, and worse birth outcomes. Women living in rural areas are more likely to die of causes linked to pregnancy or childbirth, and infant mortality is also higher.
But despite these sobering statistics, more and more rural hospitals are close their labor and delivery unitsforcing patients to travel long distances or give birth in under-equipped emergency rooms. Most of those who still give birth lose money in the process, due to low Medicaid payments and too few deliveries to break even with 24-hour staffing.
“We are reaching a tipping point where people are often more than an hour from routine prenatal care and more than an hour from a birthing hospital when their water breaks,” said John Henderson, president of the Texas Rural and Community Hospitals Organization. . “There’s no way we’re going to get the type of quality or results we want as a state when that’s the reality.” »
The Texas A&M Rural and Community Health Institute brought together more than 40 groups, representing rural hospitals, health care providers, medical schools, advocacy groups and nonprofit organizations, to create this rescue plan . They identified actions the Legislature could take this session, including increasing Medicaid payment rates, incentivizing health care providers to work in rural areas and improving overall access to health care. health for women.
“I don’t think anyone thinks we’re going to be able to restore services to the 20 or 30 rural hospitals that have closed or suspended their OB programs,” Henderson said. “But if we don’t do anything, we’ll see more follow the same path.”
Last session, the first since the overturning of Roe v. Wade and Texas’ near-total abortion ban, lawmakers Extended Postpartum Medicaid to a full year and waived sales tax on diapers and menstrual products. Ahead of this session, House Speaker Dade Phelan cited improving access to rural prenatal and midwifery care as one of his interim priorities.
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Strengthening access to rural maternity care would be a bipartisan way to show up for moms and babies in Texas, said Tom Banning, CEO of the Texas Academy of Family Physicians.
“There is no silver bullet to this. We would have done it if there had been,” Banning said. “But we just want to give them some ideas to think about in terms of legislation or possible funding strategies.” That’s the goal of this report: to give them options.”
“Code Red” proposals
Several of the top priorities focus on Medicaid, the largest payer of maternal health services in Texas. Medicaid funds half of births statewide, but in rural areas it covers between 60% and 90% of births. Medicaid is primarily funded by the federal government, but states administer the program.
This plan proposes to reimburse rural hospitals based on the actual costs they incur for childbirth, rather than a fixed rate, and to offer doctors fixed monthly payments per patient to cover the costs of medical needs. preventive, primary and maternity care. They hope it will make it more financially attractive for hospitals to continue delivering babies and to recruit the health care providers they need to do so.
The state should also make it easier for pregnant women to access Medicaid and for doctors to begin accepting Medicaid, the report said.
“The administrative burden of enrolling in Medicaid is considerable,” Diana Forester, director of health policy at Texans Care for Children, a health advocacy group, was quoted as saying in the report. “I spoke to an obstetrics group outside of Sweetwater who told me they were the only birthing unit within hundreds of miles. And they haven’t been able to enroll in Medicaid and therefore can’t treat Medicaid patients.
Last legislative session, lawmakers addressed the growing shortage of nurses by proposing scholarships, grants and loan repayment programs, and allocated additional funds for graduate medical education programs in rural and community health. But there is still much to do, says this report. The state must urgently strengthen loan repayment programs for obstetrician-gynecologists, family physicians and other health professionals who practice in rural areas, and create more opportunities for medical students and residents to train outside of big cities.
The plan also outlines ways Parliament could strengthen health care for rural women more broadly, ensuring they are healthy before and after pregnancy. As one of ten states that have not expanded Medicaid, Texas has an uninsured rate of 21.7%, the highest in the nation. Although lawmakers are unlikely to address the issue anytime soon, they could allocate more money to state-run programs like Healthy Texas Women, the Family Planning Program and the Texas Cancer Treatment Program. breast and cervix. They could also invest more money in mobile clinics and federally qualified health centers, safety-net clinics that cover uninsured or underinsured Texans.
In a legislative session focused on hot-button policy issues like school choice, immigration and property taxes, the groups that put together the rural Texas maternal health rescue plan hope to propose common-sense proposals that both sides can support, Henderson said. They will present these plans to lawmakers before the 2025 session.
“All these other priorities are billion-dollar projects. What we’re talking about is maybe $100 million,” he said. “This is not a major budgetary impact.”
“Rural communities have realized that if they come together, they can make a lot of money,” Banning added. “And in this case, it can be a force multiplier for other opportunities in these communities.” »
Disclosure: Texans Care for Children has financially supported The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial support plays no role in the Tribune’s journalism. Find a suit list of them here.