As Maryland health officials pledged yesterday to help local agencies find ways of providing health coverage to uninsured legal immigrants despite state funding cuts, health care advocates warned that the costs will be shifted to hospitals and county and city governments.
Gov. Robert L. Ehrlich Jr.'s budget plans to eliminate a $7 million Medicaid program for low-income pregnant women and children who are legal permanent residents, about 4,000 people statewide. The administration is sending letters informing people they will lose their benefits starting July 1, the beginning of the fiscal year.
S. Anthony McCann, secretary of the state Department of Health and Mental Hygiene said yesterday that the cuts are unfortunate but necessary given the budget crunch the administration inherited. In addition, he said, the administration worked to make fewer Medicaid cuts than initially proposed.
"While it's not perfect, we are trying to work with our local counties to help them improve the capacity of their centers," he said. "There are problems, but we are hopeful. And we expect that the local health departments and the other kinds of services will step up to do the best job they can to cover this population."
Without Medicaid, parents may choose to forgo routine checkups, only seeking medical treatment in emergencies and burdening hospital emergency rooms, which forces health care costs to rise, said Ulder J. Tillman, health officer of Montgomery County Department of Health and Human Services.
"So we are effectively removing preventive care for them and that's only going to end up costing the county more," she said.
On Tuesday, Montgomery County Executive Douglas M. Duncan, who is expected to run for governor next year, sent a letter to Ehrlich arguing that cutting health care for pregnant women is "unconscionable." Montgomery and Prince George's counties have the largest share of the state's immigrants.
And yesterday Mayor Martin O'Malley, another presumed candidate for governor, said that eliminating the program is "awful policy."
"It is a terrible message to send to new Americans who will make our city and our state a stronger and better place," he said. "This is certainly not in keeping with the Maryland I was raised in."
Health providers were uncertain about the impact on Baltimore, where the number of immigrants, few of whom are legal permanent residents, has grown substantially recently. A spokeswoman for John's Hopkins Bayview Medical Center, which sees many immigrant patients, said the hospital is trying to determine what the effect will be.
McCann said Maryland has been providing Medicaid for pregnant women and children who are legal immigrants since the 1990s, making it one of a handful of states to do so.
During this year's session, the General Assembly tried to stave off cuts by insisting that Ehrlich's budget include $1.5 million to cover pregnant immigrant women.
A spokesman for Ehrlich has said the administration has not decided whether to comply with the legislative directive, and McCann said the $1.5 million would not be enough to cover the women who are now pregnant and therefore still eligible for the program.
Meanwhile, health professionals pointed to the dangers of the lack of prenatal care. Women with prenatal care are less likely to have premature babies, low birth-weight babies and have fewer neonatal hospital stays than women without it, according to the American College of Obstetrics and Gynecology.
"We certainly have to get pregnant women into prenatal care early," said Tillman. "We really don't want to go back 30 or more years to just having women showing up at emergency rooms to have their babies. It doesn't make good medical or public health sense."
Montgomery County has a program for uninsured women through Holy Cross Hospital, which pays for the cost of their care. Tillman said that program sees about 400 women a year.
"Unfortunately, as far as I'm concerned, when you start taking away prenatal care for women you are taking away care from these unborn children," she said. "And these children will be born in the U.S. They are U.S. citizens, and if we do this, we are depriving them of a healthy start."
Immigrant advocates acknowledged yesterday that they were taken by surprise when they learned that pregnant women also would lose benefits.
Lobbyists for Casa of Maryland thought they had won that battle in the Assembly. When the legislature insisted on restoring $1.5 million to cover pregnant women, the advocacy group assumed that the measure would take effect.
'We were shocked'
"We thought it was for sure," said Natali Fani. "We are shocked that the governor is saying he might not get the money for this. This is a society issue; this is not a community issue."
Fani said that if Ehrlich does not comply with the legislature's request, the state will send a message that Maryland is inhospitable to immigrants.
"It's really embarrassing to have such a rich state, to have legislation or policies that will discriminate on that level," she said. "Health care is a necessity; it's a basic right. And we are denying our own residents, legal residents, of this basic right."