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Health reform promised to extend Medicaid to numerous childless women. But with states struggling to balance their budgets, women's advocates fear a scaling back. They say it's crucial for Congress to authorize more funds in coming weeks.

Trimming Costs

States are taking various measures to trim their costs.

To close its $109 million Medicaid gap, Nevada plans to ration adult diapers, eliminate hearing aid programs and require personal care assistants to purchase their own disposable gloves.

Republican Gov. Jan Brewer of Arizona claims that her state cannot afford to provide services for poor people currently on the rolls, let alone those who lose their employer- provided insurance when they become unemployed. She recently asked Congress to allow Arizona to eliminate more than 300,000 poor Arizonans from its Medicaid rolls.

Congress is unlikely to approve Arizona's request if it observes the new federal health care reform law requiring states to maintain Medicaid programs at current levels.

"Education and Medicaid are the biggest expenses in most states, so advocates for poor women without health insurance could find themselves battling parents and teachers for smaller pieces of the revenue pie," said Finger.

Republican Gov. Edward G. Rendell of Pennsylvania has threatened to lay off at least 20,000 government workers, including teachers and police officers, to reduce the state's $1.2 billion deficit in 2011. Colorado plans to eliminate all-day kindergarten for 35,000 children next year.

Unlike the federal government, which can use deficit financing, states must, by law, operate within their budgets.

Until the health care reform bill was passed, only six states provided Medicaid to childless adults. The program mainly served children from poor families, the disabled and pregnant women.

But starting in 2014, any childless adult under age 65 with an income of 133 percent of poverty will qualify. The federal government will provide extra funds to the states for poor people they add to the Medicaid rolls between 2014 and 2020.

'A Tremendous Advance'

"Covering childless adults will be a tremendous advance," said Natale Zimmer, public policy and communications director of the Older Women's League, or OWL, a Washington-based advocacy group of middle-aged and older women. "Poor childless women have had the most difficult time obtaining health insurance because few have qualified for public programs no matter how low their incomes."

Unemployment and divorce hits these women hard, she said. Employers are often reluctant to hire workers over age 50 and if they do, the jobs often don't provide health insurance benefits.

"Divorced women and widows often find themselves without health insurance because they cannot afford the premiums of individual policies," said Zimmer. "As a result, they spend their limited savings on medical care, which leaves them financially vulnerable during retirement."

Studies show that about 29 percent of poor childless adults have two or more chronic health conditions.

"That is why it is so important for the states and Congress to take steps now to preserve Medicaid programs, so that everyone can benefit by 2020 when health care reform is fully implemented," Zimmer said.

Thanks to $87 billion in stimulus funds, states were able to provide Medicaid services to 59 million poor Americans, including 21 million women who are parents, during the recent recession, the most devastating in 70 years. (Medicaid serves mostly poor children: 30 million kids, usually living in households headed by women.)

The New York-based Guttmacher Institute, a leading provider of research about reproductive health, predicts that states will save money in the long run if they find a way to provide all the Medicaid services that people in their states need. The organization says it's more efficient to expand Medicaid with its emphasis on preventive care than to leave poor people uninsured and dependent on expensive, hospital emergency rooms.

Would you like to Comment but not sure how? Visit our help page at http://www.womensenews.org/help-making-comments-womens-enews-stories.

Sharon Johnson is a New York-based freelance writer.

For more information:

Wisconsin Alliance for Women's Health:
http://www.wiawh.org

Maryland Women's Coalition for Health Care Reform:
http://www.mdhealthcarereform.org

Older Women's League or OWL:
http://www.owl-national.org

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