I am a general pediatrician in Winston-Salem at a clinic that provides care almost exclusively for patients who receive Medicaid insurance. Many of my patients’ parents are uninsured. In North Carolina, more than 15% of parents of infants and toddlers are uninsured. Statewide, at least 500,000 adults do not earn enough to purchase private health insurance, yet earn too much to qualify for Medicaid.
Why does this matter to a pediatrician? Because access to high-quality, affordable health care for a parent improves health for both parents and their children.
I recently cared for Sofia, a premature infant, in clinic. Sofia stayed in the NICU with health complications costing hundreds of thousands of dollars. Sofia’s mother had no prenatal care because she didn’t have health insurance and couldn’t afford out-of-pocket costs for prenatal visits. She worked as a child care provider at a small day care that didn’t provide health insurance to employees. Her pre-tax income of $50,000 is over the 200% poverty level threshold required for N.C. Medicaid eligibility for pregnant women. She could not afford to buy Affordable Care Act health insurance, which would have cost approximately $1,000 a month, leaving insufficient funds for rent, transportation, food, child care and daily living expenses. Lack of health insurance for Sofia and her mother resulted in cascading negative consequences: a premature birth with possible adverse neurodevelopmental issues for the child; likely additional costs to schools to fund special education needs; loss of work time for the mother to attend to more frequent visits to the doctor; and gigantic hospital costs.
States that have expanded Medicaid have demonstrated improvements in the health of women of childbearing age. These women have increased access to preventive care, improved health outcomes before, during and after their pregnancies, and reduced maternal mortality rates. These states have also seen improvement in the health outcomes for infants, including declines in infant mortality. This is especially relevant here in North Carolina, where 9.2% of babies are born at a low birth weight (compared to 8.2% nationwide) and the infant mortality rate is 7.3 per 1000 live births (compared to 5.9 nationwide).
Additionally, we know that parents are more likely to enroll their Medicaid-eligible children when they have health insurance coverage themselves. Children whose parents receive Medicaid insurance are also about 30% more likely to receive regular check-ups and necessary preventive care. Receiving consistent health care is especially essential for young children, as it sets them on a path of healthy growth and development.
I commonly see families in clinic in which one parent is struggling with depression or another mental illness. This can impact their ability to take the best possible care of their children. Mothers struggling with post-partum depression are often not able to bond with their infant, breastfeed successfully or care for their child adequately. Parents with untreated mental health problems are often unable to provide their infant, toddler or school-age child with the nurturing environment their child needs for optimal growth and development.
I also frequently see uninsured families who experience financial strain over medical bills. When health crises arise, this can quickly result in debt and financial distress. When parents are going through periods of stress, children feel the adverse effects as well. Children who experience poverty and trauma early in their life can have impaired brain development, negatively impacting their ability to learn, physical health, and emotional well-being.
Additionally, parents not currently working are better positioned to search for and retain new jobs if they have access to health care. Stable employment reduces financial stress on the entire family, providing a financially secure environment for children and lessening their exposure to poverty.
The health of parents and their children are interconnected. To improve the health of both, North Carolina must utilize available federal funding to expand access to health insurance for North Carolinians. As a pediatrician, my goal is to improve the physical, social and emotional well-being of infants, children, adolescents and young adults. One of the most important ways that our community can help to do this is to call on legislators in North Carolina to improve health care access and close the coverage gap, as 37 other states have done.
Investing in the health of children — and their parents — is both the economically sound and morally wise path for North Carolina.