Medicaid cuts could cause more challenges for expectant mothers
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Pregnant people are less likely to access prenatal care in rural counties where birthing units have shut down, despite other prenatal providers still being available locally, according to a study co-authored by a University of Iowa researcher.
Why it matters: People who attend fewer prenatal care appointments are more likely to deliver prematurely — and a University of Iowa researcher says the issue could get worse if rural hospitals close due to Medicaid cuts.
The big picture: Hospitals are steeling themselves for the effects of cuts in President Trump's budget law and are starting to plan which services they may need to roll back.
- The law's new Medicaid work requirements, which will start Dec. 31, 2026, are projected to lead to millions of people losing coverage, increasing the number of patients who can't pay their hospital bills.
- Then, starting in 2028, the law phases down taxes on medical providers that help states finance their share of program costs, and state-directed payments that hospitals say make up for low reimbursement rates in Medicaid.
Between the lines: Rural hospitals, which help patients who struggle to find eligible providers elsewhere, disproportionately rely on Medicaid. The program covered nearly half of all births in rural areas in 2023, per KFF.
- In Iowa, 20 rural hospitals are already at risk of closing, per the Center for Healthcare Quality and Payment Reform.
- The bill does allocate $50 billion for rural healthcare, but an estimate from KFF shows that isn't enough to cover the expected cuts.
What they're saying: "It's all going to end up in the emergency room, the most expensive place in the world for anything to be done," says UI professor Tom Gruca, who co-authored a study on prenatal care.
- His study found that 18% of pregnant Iowans in 2018-19 were making an inadequate number of prenatal visits to hospitals before their birthing unit closures.
- Following the closures in Hardin, Osceola, Clayton, Emmett, Lucas, Hamilton and Van Buren counties, that number increased to 22%.
- Patients on Medicaid were even more likely to miss appointments, at 38%.
Patients may miss appointments because they have to drive out of the county to receive prenatal care at the same hospital where they plan to deliver.
- Or their town may not have any Medicaid providers left, Gruca says.
Zoom out: Iowa has long ranked near the bottom nationally in terms of the number of OB-GYNs per capita, particularly in rural areas.
- As rural populations decline, it's becoming more difficult financially to provide 24/7 staffing for delivery units, which often require an OB-GYN and surgeon to perform C-sections.
- This last session, Gov. Kim Reynolds passed a rural health care initiative aimed at bringing more physicians to rural areas and also increasing the state's Medicaid reimbursement for complex pregnancies and births, per The Gazette.
What's next: Because the cuts don't take effect right away, hospitals still have the opportunity to delay when they happen.