Testimony to Senate Committee on Health & Human Services
We thank the Legislature for its commitment to women’s preventive care. We also commend the Health and Human Services Commission (HHSC) for its work to launch the Healthy Texas Women (HTW) program and the Family Planning Program (FPP). Through these programs, eligible low-income women can go to a participating provider to get health screenings, women’s health exams, and family planning, including contraception, at little or no cost. While there is still work to do to ensure successful implementation of these new programs, the launch represents a critical opportunity to revitalize consumer outreach, increase provider outreach and capacity, and serve the thousands of women across Texas who are in need of health screenings and preventive care.
Background
Healthy babies and successful kids in school start with healthy women, healthy pregnancies, and healthy moms. Preventive care and interventions before and between pregnancies are one of the most effective ways to improve health for moms and babies. We all want children to be healthy, be good learners, and grow up to be our next generation of teachers, helpful co-workers, and leaders. The first step is ensuring healthy pregnancies and healthy births. The screenings and preventive care offered through HTW and FPP are an important step towards improving women’s health and birth outcomes and reducing unplanned pregnancies. When women are able to plan or space their pregnancies, they are more likely to receive prenatal care in the first trimester and their babies are less likely be born too early (preterm) or too small (low birthweight). HTW also offers screening and treatment for diabetes, hypertension (high blood pressure), and high cholesterol, which are conditions that are critical to treat before pregnancy so a pregnancy is healthier for both mom and baby. In fact, treating diabetes and hypertension before pregnancy reduces complications, such as preeclampsia, preterm birth, low birth weight, birth defects, and infant death.
Preventive care and disease screenings and treatments save the state money and reduce health risks. Unintended pregnancy and poor birth outcomes, such as preterm and low birthweight births, have a substantial cost to Medicaid. About 70 percent of Medicaid costs for hospitalized newborns are related to prematurity. In total, Medicaid paid over $402 million in 2015 for newborns with prematurity and low birth weight. The average cost to Medicaid for premature infants is 200 times higher than the cost of healthy, full-term births. In fact, during the first year of life, a healthy, full-term newborn birth costs Medicaid about $572, while a newborn born preterm or with low birthweight complications costs $109,220 to the Medicaid program. These costs can be reduced through improved access to contraception (to plan and space pregnancies) as well as screenings and early intervention to detect health risks, such as diabetes and hypertension, before they result in complications and become more expensive to treat.
Several recent developments in Texas emphasize the urgency of strengthening preventive care access in the state. With local transmission of Zika virus as close as Florida, the threat of local transmission is looming in Texas. The wet spring has created mosquito-friendly conditions, particularly in vulnerable communities in South Texas, the Rio Grande Valley, and Gulf Coast. In Texas, about half of pregnancies are not planned, which means a large portion of pregnant women in the state may not know to take mosquito precautions. Given the devastating effect Zika virus can have on pregnant women and their fetuses, strategies and programs to prevent unintended pregnancies and sexual transmission of Zika virus are more important than ever.
Moreover, two recent reports have shown a disturbing spike in pregnancy-related deaths in Texas over the last few years. The rate of pregnancy-related deaths in the state doubled between 2010 and 2012 – a trend not seen in any other state – and pregnant Black women bear the greatest risk of pregnancy-related death and severe complications. Notably, the DSHS Maternal Mortality and Morbidity Task Force found that 60 percent of maternal deaths occurred more than 42 days and less than 1 year after delivery, highlighting the critical need for postpartum and interconception care, such as services through HTW and FPP. Given this context, continued investment in women’s preventive care and interventions before, during, and between pregnancies is critical to address and improve maternal health.