Oregon Sen. Wyden proposes legislation to preserve rural maternal care

U.S. Sen. Ron Wyden, D-Oregon, speaks on Thursday, May 16, 2024, at a Senate Finance Committee hearing on rural health care. (Screenshot)

U.S. Sen. Ron Wyden is pushing for a pathway for rural hospitals to continue to provide maternal care in small communities.

Wyden, D-Oregon, on Monday released a draft bill that outlines a series of financial incentives to encourage hospitals to continue to offer birth services. The bill includes higher Medicaid rates and additional payments to cover the cost of on-call staff for expectant mothers in small communities with low numbers of births.

Wyden’s bill is backed by 15 other Senate Democrats – one-third of the Democrats in the chamber. It comes in response to last year’s closure of the birthing center at Saint Alphonsus Medical Center in Baker City. The only maternity ward in the rural eastern Oregon county with nearly 17,000 people had served the area for a century. The move has forced expectant mothers to travel to Grande Ronde Hospital in La Grande.

“In Baker County, you have to drive at least 45 miles further to the next hospital to give birth on roads that can sometimes be impassable because of winter weather or summer wildfires,” Wyden said in a Monday press call. “We believe that Oregonians and Americans deserve better.”

The fallout in Baker City is part of a trend that’s unfolding across rural America as hospitals decide what  services to offer based on cost, demand and profitability. That’s translated into reduced birth services in rural communities, especially those with dwindling birthrates and aging populations. Between 2011 and 2021, one out of every four rural hospitals nationwide stopped providing obstetrics services, or more than 260 hospitals, according to a national report . Today, only about 45% of rural hospitals deliver babies, and in some communities, only 33% do, according to the Center for Healthcare Quality and Payment Reform . In Oregon, one-quarter of its 32 rural hospitals offer obstetrics care.

The bill would provide more funding for hospitals with a low number of births – called low-volume payment adjustments – so they continue to stay in their communities. It also would require each state to study and report the costs of providing labor and delivery services in rural areas to the U.S. Department of Health and Human Services.

The legislation would improve overall maternal services for women by offering incentives for states to expand depression and anxiety screening for mothers before, during and after birth and requiring states to provide coverage for women on Medicaid after delivery for 12 months, Wyden said.

Hospitals would be required to provide a timely notification of when they plan to close birthing centers so communities and families have adequate time to plan.

“What we want to do is find a way to create smart, cost-effective choices for the future in these communities,” Wyden said. “We recognize that these are changing times.”

The Hospital Association of Oregon, which represents 61 hospitals, said it supports the legislation.

“The proposal acknowledges the need for emergency staffing options to help rural providers temporarily fill obstetrical positions as needed, the importance of Medicaid coverage for midwives and doulas and the critical need for a simplified Medicaid enrollment process for out-of-state obstetrical providers,” the association said in a statement. “The proposal recognizes the costs involved in maintaining and staffing obstetrical units 24/7.”

Daniel Grigg, CEO of Wallowa Memorial Hospital, located in rural northeastern Oregon, said the bill is an important step in protecting access to maternity care in rural areas.

“This bill will support rural families and communities by boosting reimbursement for labor and delivery services and providing payments to hospitals with low-birth volumes,” Grigg said in a statement.

Wyden said this issue is bipartisan and he hopes to see support from both sides of the aisle.

The other lawmakers to sign on so far are Democratic Sens. Debbie Stabenow of Michigan, Maria Cantwell of Washington Bob Menendez of New Jersey, Tom Carper of Delaware, Ben Cardin of Maryland, Sherrod Brown of Ohio, Michael Bennet of, Colorado, Bob Casey Jr. of Pennsylvania, Mark Warner of Virginia, Sheldon Whitehouse of Rhode Island, Maggie Hassan of New Hampshire,  Catherine Cortez Masto of Nevada, Elizabeth Warren of Massachusetts, Tammy Duckworth of Illinois and Corey Booker of New Jersey.

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