How can so many “pro-life” lawmakers do nothing to help Wyoming hospitals keep their maternity wards open?
Opinion
Evanston Regional Hospital recently announced it will close its birthing facility at the end of the year. It will become the state’s fourth maternity ward to shutter its doors since 2016, following facilities in Riverton, Kemmerer and Rawlins.
Following the overturning of Roe v. Wade, the Legislature passed two abortion bans that stalled in state court for over two years. A Teton County judge ruled on Monday the bans were unconstitutional, but the issue is still in legal limbo with an appeal to the Wyoming Supreme Court anticipated.
Equality State lawmakers voted overwhelmingly to ban both surgical and medication methods to terminate pregnancies, and tried to justify their position by citing the state’s responsibility to protect human life. Do they believe they have no obligation to protect the lives of expectant mothers and infants who need a safe delivery facility reasonably close to home?
To be clear, this is not only a Wyoming problem. More than half of the nation’s rural hospitals do not have birthing facilities. But many of those hospitals are still within 30 miles of an urban medical center that provides such care.
Five Wyoming counties — Big Horn, Crook, Niobrara, Sublette and Weston — are classified by March of Dimes as “maternity deserts,” with no birthing facility within 60 miles. Seven more — Carbon, Goshen, Johnson, Lincoln, Platte, Washakie, and Uinta — are considered “low access to maternity care” places.
When Rawlins’ maternity unit closed, pregnant women began traveling 100 miles to Ivinson Memorial Hospital in Laramie. Imagine what it’s like to make that journey in winter, over one of the most dangerous, often closed stretches of Interstate 80.
When Kemmerer’s maternity ward closed, many expectant mothers went to Evanston. Next year, with that option gone, most women near Kemmerer will make longer trips to either Rock Springs or Utah.
According to the March of Dimes, Wyoming women who live in maternity deserts trail only Alaska and West Virginia for the longest travel time.
A 2023 study by the Center for Healthcare Quality and Payment Reform linked long commutes to hospitals with higher-risk pregnancies, complications and death, both for the mother and child.
The Legislature’s Management Council assigned the Joint Labor, Health and Social Services Committee to prioritize finding solutions to our maternity care problems. Members studied various factors contributing to the lack of providers and ways to increase access.
The reasons include the high cost of medical malpractice insurance, the abortion bans’ impact on doctors’ desire to work in Wyoming and liability concerns and barriers for midwives to deliver in hospitals.
The committee considered tort reform and creating an onramp to midwifery through training offered by community college nursing programs.
But the panel won’t sponsor any bills to consider next year. The only thing members decided was to keep working on the issue.
The problem is too acute for the Legislature not to address in January. Wyoming ranks 42nd on the State Scorecard on Women’s Health and Reproductive Care, which assesses every state’s health care system based on measures such as maternal mortality, prevention and provider access. Wyoming had the lowest score among Rocky Mountain states.
When the Evanston maternity ward closes, it will leave only 17 birthing facilities in the state’s 23 counties.
Gov. Mark Gordon’s Health Task Force subcommittee met on the topic for the past year. It explored creating OB medical fellowships, rural OB residency programs, opportunities to better use family physicians, and more regionalized maternity care across the state. All should be considered by the Legislature.
But that’s not all the governor’s office is doing. In his supplemental budget, Gordon asked the Legislature to add $2.4 million to the Department of Health’s budget to increase Medicaid rates to providers to ensure Wyoming can retain maternity care services. The cost would be evenly covered between state and federal agencies.
Gordon’s idea is a good one. About one-third of Wyoming deliveries are paid through Medicaid. The average reimbursement rate for private insurance is $20,000 but drops to only $7,500 for Medicaid births. Increasing the rate should help reduce existing wards’ risk of closing. Wyoming can’t afford to lose anymore.
The state should also increase funding for provider recruitment programs. But Rep. Mike Yin (D-Jackson), a member of the Labor, Health and Social Services Committee, told the Jackson Hole News&Guide many of his colleagues won’t spend state money to address these problems, even though it’s clearly necessary.
“The biggest aspect is that health care in a very rural state costs a lot of money because we don’t have the economies of scale of other locations,” Yin explained. “And so, we can only do so much via regulation.”
Funding will be an even bigger hurdle when the Freedom Caucus — which includes some of the most vocal pro-life House members — takes over the chamber next session. The far-right caucus’ top priority is reducing the state budget, and based on its actions last year, it will make health care spending one of its main targets.
The high cost of operating birth facilities and a steady decline in the number of deliveries are two main reasons Evanston and the other wards cited to explain their closure.
But the state’s lack of OB-GYN physicians also plays a major role. Eleven Wyoming counties do not even have a practicing OB-GYN.
I don’t think enough attention has been paid to the impact Wyoming’s abortion bans have had on physicians. Even though the bans are in limbo and abortion remains legal, the fact the Legislature passed laws that would put providers in prison obviously keeps some OB-GYNs from practicing here.
One is Natalie Eggleston from Jackson. She graduated from the WWAMI program at the University of Washington’s School of Medicine and planned to return home, but decided to practice at a Montana hospital after Wyoming passed its abortion bans.
A bill to further restrict access to abortion surgeries — intended to close Wellness Health Access in Casper, the state’s last abortion clinic — solidified Eggleston’s belief she made the right choice. When Gordon vetoed the bill, it enraged members of the Freedom Caucus, who plan to bring it back with enough votes to override another veto.
“Practicing in Wyoming still remains 100% on my radar. If I return, the state would repay a substantial amount of my tuition fees,” Eggleston told me in an interview. “But because lawmakers here are driven by unrelenting pressure from individuals and groups promoting their own beliefs, not safety, Wyoming is driving OB-GYNs like me out of state when women need them more than ever.”
In 2023, when the Legislature extended mothers’ Medicaid postpartum benefits from two months to a year, many lawmakers supported the move, touting it as pro-life.
“As a pro-life state, we’re more than pro-birth,” Rep. Steve Harshman (R-Casper) said. “We love our moms and kids.”
Wyoming lawmakers have an opportunity to prove it by enacting measures to reduce the state’s maternity desert, prevent further closures and provide others financial support to reopen.
Instead of these goals, many legislators are obsessed with taking away Wyoming women’s reproductive freedom. That will force them to either travel to states where abortion is legal or have their babies here, where 25% of the state does not provide labor and delivery care.
I don’t know how any legislator can claim to be pro-life without being committed to protecting the health of women and infants. In a rural state like Wyoming, it’s essential to provide adequate maternity care, so mothers don’t have to fear the very real possibility they will deliver their baby in a car, during a blinding snowstorm, while making a mad dash to the nearest hospital.
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