State Policymaking and Stated Reasons: Prenatal Care for Undocumented Immigrants in an Era of Abortion Restriction.

Publisher: Blackwell Publishers Country of Publication: United States NLM ID: 8607003 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-0009 (Electronic) Linking ISSN: 0887378X NLM ISO Abbreviation: Milbank Q Subsets: MEDLINE

Publication: Malden, MA : New York, NY : Blackwell Publishers ; Milbank Memorial Fund
Original Publication: New York, NY : Published for the Milbank Memorial Fund by Cambridge University Press, c1986-

Health Policy* ; Undocumented Immigrants*; Abortion, Induced/*legislation & jurisprudence ; Prenatal Care/*economics ; Prenatal Care/*legislation & jurisprudence; Adult ; California ; Female ; Humans ; Nebraska ; New York ; Policy Making ; Pregnancy ; Qualitative Research ; State Government ; United States

Policy Points States can create policies that provide access to publicly funded prenatal care for undocumented immigrants that garner support from diverse political coalitions. Policymakers have used a wide range of moral and practical reasons to support the expansion of care to this population, which can be tailored to frame prenatal policies for different stakeholder groups.
Context: Even though nearly 6% of citizen babies born in the United States have at least one undocumented parent, undocumented immigrants are ineligible for most public health insurance. Prenatal care is a recommended health service that improves birth outcomes, and some states, including both traditionally "blue" and "red" states, have opted to provide publicly funded coverage for prenatal services for people who are otherwise ineligible due to immigration status. This article explores how courts and legislatures in three states have approached the question of publicly funded prenatal care for undocumented immigrants and its relationship to the abortion debate, with a particular focus on the moral and practical justifications that policymakers employ.
Methods: We employed a review and qualitative analysis of the documents that comprise the legislative histories of prenatal policies in three case states: California, New York, and Nebraska.
Findings: This review and analysis of policy documents identified moral reasons based on appeals to different conceptions of moral status, respect for autonomy, and justice, as well as prudential reasons that appealed to the health and economic benefits of prenatal care for US citizens and legal residents. We found that much of the variation in reasons supporting policies by state can be traced to the state's position on the protection of reproductive rights and whether the policymakers in each state supported or opposed access to abortion. Interestingly, despite these differences, the states arrived at similar prenatal policies for immigrants.
Conclusions: There may be areas where policymakers with different political orientations can converge on health policies affecting access to care for undocumented immigrants. Future research should explore the reception of various message frames for expanding public health insurance coverage to immigrants in other contexts.
(© 2021 The Authors. The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Millbank Memorial Fund.)

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Keywords: Medicaid; abortion; pregnancy; prenatal care; reproductive rights; state policy; undocumented immigrants

Date Created: 20210624 Date Completed: 20211008 Latest Revision: 20220902

20221213

PMC8452360

10.1111/1468-0009.12519

34166528