“We lose money” | The press

(Gonzales, Texas) In the corridor of the birthplace wing of the Gonzales Hospital Healthcare Systems, large yellow letters are fixed at the windows of the three delivery rooms. “Our small rays of sun”, we can read, above stickers with solar shapes, where the weight and birth date of newborns are registered.

The Texas flag and the Stars and stripes float in front of the hospital entrance. The single-storey building along a high road contains the only obstetric service in the county of Gonzales, in the city of the same name. From 150 to 170 babies are born there every year.

But despite recruitment efforts, the hospital has no obstetrician gynecologist in service for almost two years.

The patient must then be transferred to another establishment, the closest being almost an hour’s drive or thirty minutes of helicopter.

Consequences of the law

The shortage of gynecologists’ obstetricians affects the whole country, and is particularly glaring in rural regions. But in Texas, where doctors risk up to 99 years in prison if they practice an abortion for a reason other than saving the life of the patient or preserving one of her organs, the crisis has a particular resonance.

The death of three patients because doctors would have been slow to carry out a procedure after a miscarriage – for fear of being accused of having practiced an illegal abortion – was largely publicized shortly after the entry into force of the law in 2022.

Elected officials adopted new clarifications last June, to calm worries: it is still necessary that the life of the patient is in danger or that there is a risk of significant deterioration of a function of the body so that an abortion can be practiced, but it is now specified that medical staff do not have to wait for this scenario to be imminent to act. A news welcomed with relief by doctors’ associations.

But 44 % of the obstetricians Texan gynecologists had already made changes to their career or thought of doing so, leaving their specialty, moving to another state or taking an early retirement, according to a Manatt Health poll published in October 2024.

“Of course, there are people on the other side of the political spectrum that are comfortable with the ban on abortion,” he adds. But it still reduces our candidates pool. »»

Financial difficulties

The severity of the law is not the only obstacle to recruitment. Nor the only reason explaining maternal health care deserts.

The financial model of establishments also explains why the less profitable obstetrics services are the first sacrificed in the event of financial difficulties.

“Delivery is not exactly a way for a hospital to make money; Insurance reimbursements are very low compared to other services, ”explains Ashley Stoneburner, director of applied and analytical research at March of Dimes. This non-profit organization is devoted to the prevention of health risks of pregnant women and newborns.

In its report published in 2024, the organization estimated that around 1 out of 25 Department of Obstetrics had closed to the country in two years.

The aging population in the region as well as the costs necessary to maintain a team available 24 hours a day and 7 days a week for a limited number of births partly explain this choice. Added to this are the responsibility insurance costs for doctors, in a field where the risks of prosecution for professional misconduct are among the highest.

Care deserts

Almost half of the Texans counties were considered by March of Dimes as “maternal health care deserts”, with limited or non -existent access to obstetric resources, while the national average was 35 %, according to data from 2024.

“We have a mother here, in western Texas, who squarely planned how she was going to line up on the side of the road to give birth,” says, in videoconference, Lisa Dillard, director of the maternal and infant health initiative of March of Dimes for the West Texan, installed in Lubbock.

Even when an obstetric service is accessible, as in Gonzales, small hospitals are not always equipped to follow risk pregnancies and run patients to large centers.

Travel and accommodation costs can quickly increase for families, especially if several round trips are required.

“We receive patients who live several hours away from a distance, but who must give birth in a specialized obstetric unit like ours,” explains the D on the phone^D Deborah Fuller, obstetrician gynecologist in Dallas.

Maternal care deserts are also places where access to very short health care is deficient. “Unfortunately, it is quite frequent that women with chronic health problems live in a maternal health care desert,” added the D^D Fuller. This increases the risks of premature delivery or complications.

Medicaid and the Big Beautiful Bill

All this in a context where rural hospitals have been getting financially for ten years.

A quarter of adults in the region are provided by Medicaid, a program for those who do not have access to private insurance.

Refunds do not allow the costs for obstetric services to be covered, deplores Mr. Anzaldua, seated in his office with gray walls. “We lose money,” he said, estimating 95 % the number of pregnant patients covered by Medicaid who give birth in his hospital in Gonzales.

He hopes that the new economic law – the famous Big Beautiful Bill Adopted at Congress on July 4 – will bring hospitals in the regions. The Republicans have promised 50 billion US over five years for rural health care, where a large part of their supporters are located.

But cut in federal expenses linked to Medicaid are estimated at 911 billion US over 10 years, and are likely to receive rural populations, according to the health organization KFF.

Despite everything, Mr. Anzaldua does not envisage the closure of the short -term obstetrics service. “We would continue to have to give birth to women, who would present themselves to the emergency room, but in an environment at higher risk,” he said. And it is also a community service. So as long as the board of directors agrees, we will maintain the service. »»