Medicaid Pays for 53% of Births in Arizona. Other States Are Close.

Taxpayers pay for over half of all births in Arizona. That costs the state $220 million a year. Or maybe $262 million. Nobody seems to know.

The percentage keeps rising. It was 42% in 2000.

That is the first step in womb-to-tomb welfare.

This 53% figure is said to have caught politicians by surprise. If true, Arizona has truly naive politicians. The numbers have risen for two decades. Free health care is a big lure.

The share of births paid for by Medicaid has been rising steadily since 1990. That growth hit a significant milestone in 2003 as it passed 50 percent, meaning that state-funded births outnumbered for the first time the number paid for by parents or their insurance companies.

Then we read this:

“I had no idea that the number had grown to that ridiculous level,” said Rep. John Kavanagh, R-Fountain Hills, chairman of the House Appropriations Committee. “That’s shocking and depressing.”

He is shocked. Shocked!

We also learn that “the state doesn’t compile the precise full annual cost of Medicaid-funded births, though it does track the number of births.”

It took a newspaper to follow the money.

If you think Arizona is a special case, think again.

The rise in Medicaid-covered births is not unique to Arizona. Nationally, state Medicaid programs on average cover about 40 percent of births, according to Families USA Deputy Executive Director Kathleen Stoll. Only about a dozen states’ public-health programs have seen the share of publicly funded births pass 50 percent, but many more are getting close.

The newspaper is correct: “Absent scrutiny from a state agency or public officials, there’s no way to know exactly why the trend continues or what — if anything — should be done to address it.”

Nothing will be done. Medicaid is required by federal law.

The rising costs of Medicaid-funded births, which do not appear as a line-item in the state budget and are paid for with a combination of state and federal money, never came up.

AHCCCS spokeswoman Monica Coury said the state maintains “extensive data in a data warehouse” on the costs associated with births covered through AHCCCS, but did not have the figures readily available. “There are multiple codes involved in prenatal care and labor and delivery and complications associated and when the cost of the birth becomes the cost of care to the child, etc.,” she said in an e-mail. “Costs of ‘births’ are incredibly complicated.”

In short, nobody was assigned the responsibility of following the money. Was this stupid, or was it deliberate? It makes no difference. Nothing will change.

In Texas, Medicaid funds 57% of births. Illinois funds more than 50%.

Let’s look at some numbers.

Based on those averages, the AHCCCS-covered fees for delivery and care at all hospitals immediately after the birth for mom and baby are $4,386 each, and add up to $198 million for all of the 2011 covered births in Arizona. The state’s Joint Legislative Budget Committee puts the 2011 costs at $262 million.

But neither of these totals includes other care that’s covered, such as pre- or postnatal doctor visits, pregnancy tests, ultrasounds or treatment for any problems that may arise before, during or shortly after delivery. Women in the program are covered during pregnancy and for 60 days after. Babies are covered for a year, and then can stay on AHCCCS if they qualify under the separate program for children.

Sen. Sylvia Allen, R-Snowflake, estimated that including pre- and postnatal care, it costs Arizona about $7,500 per birth for a delivery with no complications. Using those estimates, the 2011 deliveries would have cost Arizona taxpayers nearly $338 million.

And so it goes.

What about illegal immigrants? Don’t ask. It’s not politically correct to ask.

One piece of the trend that has been debated is coverage of illegal immigrants. Some state lawmakers have criticized the fact that Arizona continues to pay for illegal-immigrant mothers to give birth, but federal law requires that the state cover labor and delivery costs as part of emergency care. Arizona is not among the 14 states that cover more extended prenatal care for illegal-immigrant women, according to Stoll. AHCCCS also does not track the number of or how much Arizona pays for labor and delivery services for illegal-immigrant mothers through the emergency-services program.

About 65% of the mothers receiving funding are unmarried. The unofficial slogan for the program is simple: They play. We pay.

When these children come to voting age, do you think they will vote to roll back the welfare state? On oldsters, yes. On their age group, no.

The state’s unofficial accounting slogan is this: Don’t ask. Don’t tell.

State lawmakers in key positions on legislative budget and health committees said they knew nothing of the trend, despite the information being at their fingertips. The Arizona Department of Health Services each fall releases a 500-page annual report documenting these and other state health trends. The 2010 report, available online, includes a graphic showing the rise in AHCCCS-funded births from 2000 to 2010.

This is everywhere. It’s not just in Arizona.

Most states cover women whose family income is higher than Arizona’s $28,635 limit. Arkansas, for example, covers women with an income of less than $30,925 for a family of three; Iowa and Wisconsin cover women with an income of less than $57,270 for a family of three. Nine states, including Utah, Colorado and Nevada, cover women whose family’s annual income is less than $25,390 for a family of three. That is the minimum allowed by federal law.

Is the USA going bankrupt? No. Are its governments going bankrupt? Yes. This is a slow-motion train wreck. We can at least have fun watching. This is where the welfare state will end: a magnificent pile-up.

We told them so.

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