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Women's health has been a point of much controversy in the ongoing health care debate. Federal funding for abortion is already illegal in most cases, but many abortion rights opponents want to permanently block Planned Parenthood from getting federal dollars for services like contraception. That's Medicaid money. Maternity care gets a lot less attention, though it's also a critical part of Medicaid. And as NPR's Sarah McCammon reports, it turns out anti-abortion rights groups also rely on Medicaid to help low-income pregnant women.
SARAH MCCAMMON, BYLINE: When Taylor Merendo moved to Indiana two years ago fleeing an abusive spouse, she needed help.
TAYLOR MERENDO: I was six months pregnant. And at that point in time, I really didn't have a stable place to live.
MCCAMMON: That's where the Hannah Center in Bloomington stepped in. It's what's known as a crisis pregnancy center, where women are counseled against abortion and often get help after their babies are born. Executive director Tina Tuley-Lampke says many low-income women come in believing they need to have an abortion, and she tries to persuade them otherwise.
TINA TULEY-LAMPKE: Because for many women, it's not truly a choice when they feel like they don't have any other options.
MCCAMMON: The nonprofit housed Merendo for about a year in its maternity home and helped her apply for Medicaid in Indiana. Low-income pregnant women qualify automatically, though exact income requirements vary from state to state.
UNIDENTIFIED BOY: (Laughter).
MCCAMMON: Now 21, Merendo is caring for her 19-month-old son and training to become a nursing assistant.
MERENDO: I love you.
MCCAMMON: She says she never wanted an abortion, but she couldn't have paid for her prenatal visits.
MERENDO: And then the delivery alone, if Medicaid wouldn't have paid for it, it would have been thousands of dollars. And being a single mother, you really just can't pay for that.
MCCAMMON: A lot of women can't. For pregnant women in the United States, Medicaid is less a safety net than a building block of the maternity care system. Dr. Hal Lawrence is with the American College of Obstetricians and Gynecologists.
HAL LAWRENCE: There are 4.3 million births in this country. So over 2 million of those births are covered by Medicaid.
MCCAMMON: That's close to half. And for the Hannah Center in Bloomington, it's at least 90 percent. Directors of several similar organizations interviewed by NPR indicated that most of their clients also end up receiving Medicaid. An NPR review found at least two dozen such centers advertising online that they offer Medicaid referrals or enrollment assistance.
ANDREA KRAZEISE: Oh, yeah, I mean, that's a primary service that every pregnancy center offers, is the proof of pregnancy.
MCCAMMON: Andrea Krazeise runs the Pregnancy Center of Sanford near Orlando. Without Medicaid, she says, many of her clients wouldn't see a doctor until the very end of the pregnancy.
KRAZEISE: So I think that's what would happen, is that she would go to the emergency room or she would have no care. And then when she starts to - you know, her water breaks and she's about to go into labor, then she'll be in the emergency room.
MCCAMMON: At ACCESS Pregnancy and Referral Centers in Metairie, La., Michelle Black works with clients like little Haven Lang and her mom Tara, whose delivery earlier this year was covered by Medicaid. Medicaid has been targeted for cuts under recent Republican proposals in Congress. Black worries that could in turn push states to slash reimbursements to physicians. She says that would hurt the maternity clinic her organization also runs and make it harder for pregnant women to find doctors.
MICHELLE BLACK: I mean, it's a major concern. We've actually seen fluctuations in the amount of money that we get reimbursed through the clinic, and I know that doctor offices are seeing that as well. So in some cases, you know, people who have accepted Medicaid in the past aren't because the reimbursements have shrunk.
MCCAMMON: Back in Indiana, Tina Tuley-Lampke says she's occasionally caught flak from her conservative Christian donors for helping women enroll in government services. But she says she's seen several women decide to continue their pregnancies after learning their medical care would be provided.
TULEY-LAMPKE: Sometimes simply explaining to them we can help them through the process of obtaining Medicaid is all it takes for them to realize, you know, I can do this. I can be a mom. And so it is very ironic to me that people who are pro-life would not also be pro-Medicaid.
MCCAMMON: And she says after pregnant women get this basic health care, they can then focus on things like their education and career. Sarah McCammon, NPR News.
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