Citing the fallout from rural hospitals that have closed obstetrical units, Senate Finance Committee Chair Ron Wyden (D-Ore.) Monday offered a framework to increase pay for such care.
Wyden in a conference call with reporters discussed draft legislation that would boost Medicaid rates for labor and delivery services at certain hospitals.
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Wyden cited data from the Chartis Group estimating 267 rural hospitals stopped providing obstetrics care between 2011 and 2021, driven by escalating costs, falling birth rates and decreased staff capacity. A March of Dimes survey last year found more than a third of counties do not have obstetric providers or a facility offering such services.
Pregnant patients could face the prospect of long trips to get to care, which Wyden noted raises risks for them and their babies. The Centers for Medicare and Medicaid Services recently asked for input on what it could do to address issues related to maternal health.
The draft bill, to be called the Keeping Obstetrics Local Act, would raise the base Medicaid payment rate for labor and delivery services — which varies by state — to 150% of the Medicare rate. The revised rate would apply to rural hospitals and those for which at least 60% of births are paid by Medicaid, the Indian Health Service or self-payers. The draft legislation would raise the federal medical assistance percentage for eligible hospitals so states would not have to make up any shortfall.
The proposed legislation would also create "anchor payments" to offset high fixed costs. Eligible hospitals that have fewer than 300 births per year on average would get an extra 25% added to the hospital's Medicaid payments for labor and delivery services, as well as an annual supplement that would be higher for facilities with fewer births.
It would include provisions to help ensure larger hospital chains spend the addtional funding locally, Wyden said.
Since the bill is still being written, cost estimates were not available, he said.
The proposal has more than a dozen Democrats on board, but it would be unlikely to advance if the Finance Committee chair cannot get some Republicans to sign on. Wyden said he was trying to do so, and noted that pharmacy benefit legislation he rolled out in a similar manner eventually got unanimous support from his committee. He also pointed out that many Republican senators face the problem of obstetrics unit closures in their states.
"The Senate is essentially a very rural institution," Wyden said. "We've got a lot of colleagues who already have been interested in this issue, and I believe we can make it bipartisan."
While the unknown price tag of any legislation would likely be a significant issue for lawmakers who would prefer to cut federal spending, Wyden suggested cost was a secondary concern, given the nature of the problem.
"I just don't think you can afford not to pass legislation like this," he said.
