The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
Ripple effects of potential federal funding cuts have been spotlighted by advocates in essentially every sector, from the overall economy to school lunches and infectious diseases. But one such potential cut, and a proposal in the Ohio House’s version of the state budget, could directly impact an issue the state has been struggling to improve for decades: infant and maternal mortality.
Ohio has beennear the bottom of rankings for infant mortality rates in the country, and has seen significant maternal mortality rates as well. With children making up one-third of national Medicaid enrollment and 40% of all births in the country covered by Medicaid, cuts to that program could mean even more struggles for the state’s children and mothers.
Part of the problem that already exists within the Medicaid system, specifically in Ohio, is a low reimbursement rate that results in some physicians refusing to accept Medicaid patients, and other facilities, like Planned Parenthood of Greater Ohio, relying on donor support to compensate for the low reimbursement rates.
“Even when we talk about infant mortality, this Medicaid reimbursement rate is a huge factor in why the infant mortality rate is so abysmal,” said Erica Wilson-Domer, president and CEO of the greater Ohio arm of Planned Parenthood.
Of the patients who seek care from the facility, 43% are covered by Medicaid, which includes coverage for wellness exams, vaccines and cancer screenings, among other services, according to Planned Parenthood.
“I am deeply concerned about the potential cuts to Medicaid and what it will to do the overall health of Ohioans,” Wilson-Domer said.
She also pointed to rising rates of sexually transmitted diseases like syphilis as a timely reason to avoid cutting public health funding. A report from the Cleveland Department of Public Health showed an increase in syphilis case rates “across all age groups,” but individuals age 30-39 had the highest case rate from 2019 to 2020.
Male Cleveland residents saw a case rate of more than 150 per 100,000 residents in 2021, and cases in women, which had previously been “stable” from 2017 to 2020 nearly doubled in 2021, according to the Cleveland report.
Loss of care
Cuts in health funding, particularly Medicaid funding could not only impact those who are covered under the program, but also medical facilities across the state, even those who may not accept Medicaid.
“If there’s lost access to preventive care, that moves care to emergency rooms,” Wilson-Domer said. “Remember, it’s more expensive to go to the ER, and these patients don’t have the ability to pay, so the burden is on the hospital.”
Those who may have commercial insurance will see impacts too, if ERs are now filled with those who no longer have Medicaid coverage. Wait times could increase for everyone, even those who go to emergency rooms for truly emergent issues, Wilson-Domer said.
State funding decisions in the Ohio House budget proposalcould add to the uncertainty, as the House absorbed a proposal from Gov. Mike DeWine’s executive budget to cut Group VIII, or the Ohioans who are part of the Medicaid expansion program, if the federal contribution to Medicaid drops below 90%.
Advocates have said that will leave around 770,000 Ohioans without health insurance, leaving them with few options for care.
As discussions pop up on the federal side about encouraging women to have children through one-time funds, lowering of funding in the Medicaid program could result in more women delaying care and impacting their pregnancy because of a lack of access to the health care they need.
With the reimbursement rate low, and the potential for cuts to the state program if federal Medicaid contributions are lowered, pregnant individuals and their children could face an uncertain future.
“What ends up happening, there’s a newly pregnant person on Medicaid, but they can’t find a provider who will see them, and so they don’t end up being seen until later in the pregnancy,” Wilson-Domer said.
If the pregnant individual develops conditions like gestational diabetes or other treatable conditions, a delay in care could mean it’s too late to treat those conditions.
“If we want to really impact the maternal mortality and the infant mortality rate … what we need to do is increase the reimbursement rate so people will want to see these patients,” according to Wilson-Domer.
Reproductive health
The GOP fight over reproductive health has led to a slashing of “family planning” grants at the federal level impacting Title X funds, talk ofnational abortion bans, government websites on reproductive health being taken down and threats of defunding Planned Parenthood all together, which all tie in to discussions about reducing medical care for low-income families through Medicaid, according to advocates.
A study by the Gender Equity Policy Institutefound that those living in states with abortion bans were nearly 2 times as likely to die during pregnancy, child birth or shortly following birth, compared to states that allow abortion.
The maternal mortality rate worsens for Black mothers in states with bans, with the GEPI finding those mothers were 3.3 times more likely to die compared with White mothers in the state.
“Even before abortion was outlawed, the states that subsequently banned abortion had worse outcomes on key indicators of reproductive health,” the GEPI stated.
Ohio couldn’t enforce the six-week ban that was put in place in 2019 because of court challenges, but once Roe v. Wade, the U.S. Supreme Court decision that legalized abortion nationwide, was overturned, Attorney General Dave Yost quickly sought for a court to break the ban of its court challenges, which a federal court did.
The six-week abortion ban was in effect for a short time before abortion rights advocates sued to get the ban struck down. Enforcement is currently stopped once again, after a Hamilton County Courtsided with abortion clinics and advocates that the new constitutional amendment passed in November of 2023 gave abortion rights to Ohioans.
The court’s decision is currently under appeal with the First District Court of Appeals, but Yost has said he’s not appealing the decision to strike down the abortion ban, but instead argues other parts of the court decision overreach to the state laws that regulate reproductive health and abortion services.
Other provisions in Ohio law that impact abortion services have been overturned in court, like a 24-hour waiting period required before abortion services could be conducted, and another rule against virtual visits to provide medication abortion services.
Wilson-Domer said Planned Parenthood of Greater Ohio and their supporters “continue to bang our heads against the wall with legislators” to inform them that the health and Medicaid services dollars are “critical,” that the loss of those funds would impact all Ohioans, and that current laws that regulate such services at health clinics that also provide abortions are not only unconstitutional, but unhelpful.
“What we seek to do is provide a safe space for people to get good medical care that they need,” Wilson-Domer said.
