More than half of Arizona's babies are born under the state health plan for the poor a positive trend, in the view of public-health experts, while others see it as a drain on taxpayers.
The trend follows recent policy changes that allow more individuals and families to qualify for free or low-cost care, as well as the ever-increasing costs of private health insurance.
It also reflects the fact that Hispanics the group most likely to be poor and least likely to have private health insurance are having more babies than any other group in Arizona.
The trend would continue upward under an Arizona Senate budget proposal that would allow more women to qualify for prenatal care through the Arizona Health Care Cost Containment System.
AHCCCS paid for 53,121 baby deliveries last year, about 52 percent of the state's 102,042 births, continuing a trend that started in 2003.
That's up from 42 percent in 2000, the year before higher AHCCCS income limits were enacted, allowing more of the "working poor" to enroll.
AHCCCS says it paid, on average, more than $4,200 for each birth it covered last year a $223 million expenditure that also covered prenatal care for most of those babies' mothers.
Study after study has shown that every $1 spent on prenatal care saves $3 or more in newborn intensive-care costs and other expenses tied to mother and baby health problems that could have been prevented.
But policy experts still split on whether the state should bear so much childbearing expense.
Jack Jewett, senior vice president of TMC Healthcare and an appointee to the state's new First Things First early-childhood-development board, said the state is doing what voters told it to do.
"We as citizens and voters have said there's a need, and we want to meet that need, and that's happened in elections," Jewett said, referring to three ballot initiatives passed by voters over the last 10 years, demanding more health care for the poor in 1996 and 2000, and creating First Things First last year.
Darcy Olsen, president of the conservative Goldwater Institute in Phoenix, agreed that "most Arizonans would certainly support the idea of AHCCCS helping the truly needy and indigent. But now they are helping families who are middle-class."
Olsen was referring to Kids-Care Parents, which covers adults whose children are enrolled in KidsCare and with incomes up to twice the AHCCCS limit up to $40,000 a year for a family of four.
"Some lawmaker said, 'It won't be long before Paris Hilton will qualify for AHCCCS,'" Olsen said. "People who can pay for themselves certainly should."
First-time parents Casey Hamm, and Marcelo and Candelaria Ramirez, say they needed AHCCCS' help.
Hamm, 25, is an unmarried, uninsured University of Arizona student who gave birth Monday at Tucson Medical Center to son Caden Hansen. Hamm went to school and worked through her pregnancy but not at a job that offered affordable health-care coverage.
"I was able to get prenatal care from the beginning. It was awesome," said Hamm, who is working toward a business degree that she hopes will lead to a bright career and a secure future for her family.
The Ramirezes want the same for their family, which now includes 2-month-old Christopher.
Like Hamm, they heard about AHCCCS "by word of mouth," they said last week, while waiting to see their pediatrician at El Rio Community Health Center's Southwest-Side clinic.
But on his construction worker's pay, insurance is unaffordable at least for now, they said. And besides, his wife said, AHCCCS is "a very good program" that provides good service.
The Ramirez family represents another significant trend. Hispanics make up about 29 percent of the state's population. But since 2003 they have accounted for the largest share of births in Arizona including 44 percent of all babies born last year, according to the Arizona Department of Health Services.
Babies born to non-Hispanic white women accounted for 42.6 percent of all births last year, the health department says.
Tucson Medical Center and University Medical Center deliver more babies than any other local hospital, with well more than half covered by AHCCCS. Of the more than 6,500 babies born at TMC last year, AHCCCS paid for 57 percent.
UMC delivered 2,500 babies last year, and more than 70 percent were under AHCCCS particularly high, UMC says, because the UA doctors who work at UMC also work at clinics that serve AHCCCS patients.
"It's about prevention," said Vicki Began, UMC vice president of women and children's services. "I'm a nurse, and I'm going to say I would rather see AHCCCS spend money on prenatal care because it costs a lot less in the long run and it's better for the mom and the baby.
"We're going to pay as taxpayers, one way or the other. And it's getting harder and harder to afford health insurance."
Close to 78 percent of all women giving birth in Arizona in 2005 started prenatal care in the first three months of their pregnancy up from about 71 percent in 1995, according to the Department of Health Services.
But that's still below the national average of 84 percent.
Only women who can prove their citizenship get prenatal care from AHCCCS. For noncitizens illegal immigrants, and immigrants who live here legally but are working to obtain citizenship AHCCCS will cover baby deliveries only. That's in keeping with the AHCCCS policy of providing only emergency care to noncitizens, and a woman in labor is considered a medical emergency.
At TMC last year, 1,210 babies were born to noncitizen mothers about 18 percent of the hospital's total births, said TMC spokeswoman Julia Strange.
While most state Medicaid programs are covering more births than they used to, the national average is around 40 percent of all births, said Alina Salganicoff, vice president and director of women's health policy at Kaiser Family Foundation, a health-care research group.
In most cases, pregnant women can get into AHCCCS if their incomes are within 133 percent of poverty level about $18,200 for a single woman.
That's the lowest income limit allowed by Medicaid, Salganicoff said, but it would increase to 150 percent under a budget proposal from state Sen. Barbara Leff, a Paradise Valley Republican.
Leff initially proposed increasing the limit to 185 percent and is frustrated that Senate leaders settled on 150 percent.
"Any increase is an improvement," Leff said, "but the leadership is looking at this backwards. They see this as an outright cost. I see it as a savings. They're being shortsighted by not caring for these mothers."
Senate President Tim Bee, a Tucson Republican, said he and Democratic Gov. Janet Napolitano, who has final say on the state budget, fully support the 150 percent increase.
"I think it will be in" the budget that gets passed, Bee said Saturday. "These are young families starting out. Prenatal care is clearly something that's very important for the health of these babies and mothers."
Many policy experts say Arizona needs to look at the family-planning benefits it provides low-income women.
Nearly 20 percent of the babies born at TMC last year were to mothers 20 and younger. Another 55 percent were born to mothers 21 to 30. If those young mothers want to delay their next pregnancy, AHCCCS will pay for birth control but only for two years. Arizona is one of 26 states that pay for birth control for low-income women, but one of six states that have the narrowest coverage, Salganicoff said. Arizona also limits the birth-control benefit to women who have already had a child.
Overall, Arizona has made progress in caring for the poor and "working-poor," policy-makers agree. But the state's uninsured population has hovered around 18 percent for the last 10 years. The national average was 15 percent in 2005, says the Kaiser Family Foundation.
TMC's Jewett, a former state legislator, said lawmakers have long been concerned about the costs of AHCCCS.
"From the beginning, legislators viewed it as this potentially enormous vacuum that would just suck up state dollars."