Approximately 70% of practicing ob/gyns in the United States provide care for women with Medicaid in their daily practice. Indeed, ACOG recently encouraged all policy makers to understand the critically important role Medicaid plays to women’s health, providing healthcare coverage to 49 million women. The fact is, girls enrolled in Medicaid as children are more likely to attend college, with an estimated $656 increase in wages for each additional year of Medicaid coverage from birth to age 18.7,8
The ACA significantly expanded both eligibility for and federal funding of Medicaid. Individuals gaining access through Medicaid expansion programs increased their use of mammography and cholesterol checks by 60% and 20%, respectively.9,10 Medicaid covers prenatal care, ensuring healthy moms and healthy babies. Medicaid covers 48% of US births, and 75% of public family planning dollars.11-13
Medicaid expansion programs in 32 states, including the District of Columbia, have increased use of primary care, improved affordability of medications, reduced likelihood of emergency department visits, and increased outpatient visits, screening for diabetes, and care for chronic conditions. The number of adults reporting excellent health increased significantly.12,14
The Women’s Preventive Services Initiative (WPSI), led by ACOG Past President Jeanne Conry, MD, PhD, outlined preventative health services for women by age group based on the best evidence.15 All physicians and other healthcare providers who care for women should inform them of age-appropriate preventative health screenings such as mammography, cervical cytology, and colonoscopy. For poor and uninsured women, such preventative screenings would not be possible without the provision provided in the ACA and through Medicaid Expansion.
When Texas ended state funding for Planned Parenthood clinics, Medicaid births increased by 27%, making it a truly penny-wise and pound-foolish policy move.
Dangers of stereotyping
In 2002, the Institute of Medicine (now the National Academy of Medicine) published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.14 That report addressed the potential harm accruing patients because of providers’ cultural biases and ignorance as related to bias, stereotyping, prejudice, and clinical uncertainty.
In 2010, the Association of American Medical Colleges (AAMC) asserted, “Assembling a workforce that is diverse along many dimensions is critically necessary, but not sufficient to adequately care for patients from different populations. Medical students and physicians must learn how to handle each patient sensitively and competently. They require training on the effects of values, needs, traditions, and perceptions of patients from backgrounds that differ from their own.”15
Clinicians involved in medical education must remind their students, residents, and faculty that social issues are quite literally found in the back yard of medical training programs. Many teaching hospitals serve poor and minority populations in the immediate surroundings of that community. We all must examine how our personal background and education prepares us to care for patients from diverse backgrounds and circumstances.
ACOG policy also compels our members to fulfill their responsibilities “to assure [our nation meets] the health needs of all women. Fellows must not discriminate against patients based on race, color, national origin, disability, age, religion, marital status, sexual orientation, perceived gender, or any other basis. … Expanding health coverage to all Americans must become a high priority.”