Sorry, I just don’t see it happening.
Twenty five years ago, the Texas Legislature passed a sweeping set of reforms to resuscitate the state’s collapsing rural health care system.
Now, health care providers, advocates and local leaders are proposing similarly aggressive action to pull the rural maternity care system back from the brink. The Rural Texas Maternal Health Rescue Plan is a package of proposals they’re hoping lawmakers will champion in this upcoming session.
Almost half of all Texas counties offer no maternity care services, and more than a quarter of rural mothers live more than 30 minutes away from the nearest provider. Living in a “maternity care desert” contributes to delayed prenatal care, increased pregnancy complications and worse delivery outcomes. Women living in rural areas are more likely to die from pregnancy or childbirth-related causes, and infant mortality is also higher.
But despite these sobering statistics, more rural hospitals are closing their labor and delivery units, leaving patients to travel long distances or deliver in under-equipped emergency rooms. Most of those that do still deliver babies lose money in the process, due to low Medicaid payments and too few deliveries to break even on round-the-clock staffing.
“We’re reaching a tipping point where people are frequently more than an hour from routine prenatal care, and more than an hour from a delivering hospital when their water breaks,” said John Henderson, president of the Texas Organization of Rural and Community Hospitals. “There’s no way we’re going to get the kind of quality or outcomes we want as a state when that’s the reality.”
The Texas A&M Rural and Community Health Institute convened more than 40 groups, representing rural hospitals, health care providers, medical schools, advocacy groups and nonprofits, to create this rescue plan. They’ve identified steps the Legislature could take this session, including increasing Medicaid payment rates, incentivizing health care providers to work in rural areas and improving overall women’s health care access.
“I don’t think anyone thinks that we’re going to be able to restore services at the 20 or 30 rural hospitals that closed or suspended their OB programs,” Henderson said. “But if we don’t do something, we’ll see more go the same way.”
Last session, the first since the overturn 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 listed improving access to rural prenatal and obstetrics care as one of his interim priorities.
The proposals they have in mind are all perfectly reasonable, probably not controversial, and relatively inexpensive. There’s only a passing reference to expanding Medicaid in the story because we all know that’s not going anywhere. I’m not saying that any of this is impossible, or even particularly difficult, if the Lege wanted to do it. What I am saying is that these trends have been in place for years, and much like expanded gambling there’s always talk about Doing Something, which is then followed by no action. It’s not that any of this can’t be done, it’s that the Lege and its Republican majority and leadership aren’t interested. Their record is clear. I don’t expect that to change.