Making sure pregnant women have the health care and prenatal services they need should be one of Maryland's top priorities. That is why we were so surprised and disappointed to learn that Gov. Larry Hogan's proposed budget could deny Medicaid benefits to up to 1,400 lower income pregnant women. We call on the governor to restore this unconscionable $9 million budget cut. If it is not possible to do this with present revenue, we will push for our proposed tobacco tax increase to provide the necessary funds.

The Hogan administration asserts that pregnant women who earn between 185 percent and 250 percent of the federal poverty level no longer need Medicaid because they can get subsidized health care coverage under the Affordable Care Act. Unfortunately, many of them will not qualify for this coverage.


A problem called the "family glitch" in federal law denies subsidies to a pregnant woman whose husband has affordable health coverage from his employer even if she does not have access to such coverage. Women in this situation can now get their prenatal services through Medicaid, but under the Hogan budget, they would not have access to any affordable coverage that could provide these necessary services.

Many other women who are uninsured and become pregnant may not get ACA coverage because pregnancy, unlike marriage or the birth of a child, is not considered the kind of life change that can allow someone to purchase marketplace coverage at any time outside of limited open enrollment periods. These women would then not have affordable access to the kind of pregnancy-related services that can keep a mother healthy and assure a safe delivery and healthy child.

A healthy pregnancy reaps rewards for a lifetime. Study after study shows that early and ongoing prenatal care improves birth weight and decreases risk of preterm delivery. According to a 2012 study in the American Journal of Perinatology, "risk of prematurity, stillbirth, early and late neonatal death, and infant death increased linearly with decreasing (prenatal) care."

The costs of low birth weight and premature births, which can result from inadequate prenatal care, can be staggering, sometimes creating a lifetime of health problems for the children. Research from the University of Minnesota says that, "caring for a premature baby in an incubator in the Neonatal Intensive Care Unit (NICU) can cost $5,000 per day. Thus, 100 days in the NICU costs about half a million dollars." The $9 million dollars a year that the Hogan Administration would save from unhealthy and shortsighted cuts could very quickly be far exceeded by the costs of neonatal care that could have been prevented by adequate prenatal services.

That is why we ask Governor Hogan to restore these cuts. If he does not, we will press hard for a dollar increase in the state tobacco tax, which would provide the money we need to restore Medicaid coverage to these pregnant women. Raising the tobacco tax would also save lives by reducing smoking, particularly among young people. In 2008, Maryland raised our tobacco tax by one dollar to help expand Medicaid eligibility to more low income parents. As a result, over 100,000 Marylanders got health insurance coverage and the rate of tobacco use in our state declined at a pace twice the national average since then. It is estimated that the tax alone saved 70,000 Marylanders from tobacco-caused illness and death. And, when we increased the tax on little cigars in 2012, there was an 18 percent drop in teen use of these deadly products, saving many more Maryland young people from tobacco-caused illness and death.

Increasing the state tobacco tax by one dollar per pack would also keep mothers and their babies healthy by adequately funding tobacco prevention programs for pregnant women and others, which are now underfunded. Studies show that mothers who smoke have double the rate of premature delivery compared to nonsmoking mothers and that there is a clear relationship between the number of cigarettes smoked during pregnancy and low birth weight babies.

Governor Hogan said that he wanted to roll back taxes without jeopardizing government priorities, but his proposal tries to balance our budget on the backs of some of Maryland's most vulnerable families. We look forward to working with the governor on strategies we can agree on to help make our state stronger and healthier one healthy pregnancy at a time.

Sen. Rich Madaleno is vice chairman of the Senate Budget and Tax Committee; his email is Del. Eric Luedtke is a member of the House Ways and Means Committee;