Born in the U.S.A.

Pre-natal program falls victim to pork-barrel politics — putting poor mothers and their unborn children at risk

Leslie Herrera has been vomiting for four months — three, four, sometimes five times a day. Unable to keep solid food down, she drinks Pedialyte, a Gatorade-like drink that keeps her hydrated.

"I almost only stay in bed because I am very nauseous," she explains in Spanish. "And I am losing weight."

Dropping three-and-a-half pounds is frightening when you're four months pregnant, especially if you can't see a doctor. Uninsured and unemployed, Herrera is also an illegal immigrant, and thus ineligible for Medicaid.

There is one last safety net, however — a state program called Babies Born Healthy, which provides prenatal care to poor, uninsured women.

But the program is so underfunded that it can't help her. In metro Atlanta, counties who receive funding from the program consistently run out of money by the middle of the fiscal year.

Efforts in the state General Assembly to double the program's funding this year were blocked by Gov. Barnes, and its attempt to give the program an end-of-the-year boost may meet the same fate. If this year is like last year, thousands of women like Herrera will end up without care.

"There's a large population of people who are not getting prenatal [care] because there's not enough funding for this program," says Robert Taylor, director of the North DeKalb Medical Center.

For Herrera, seeing a doctor wasn't always this difficult. When she first moved to the U.S. from Guatemala 12 years ago, she lived in New York with a boyfriend and got a job on a Long Island flower farm. In 1992, she became pregnant with her first daughter, Wendy. Medicaid paid for prenatal care and delivery.

At that time, Medicaid, the federal health-insurance program for the poor, operated on a system of "presumptive eligibility": If you were pregnant and poor, you'd receive services. No one asked to see your Social Security number, as they do now. The Medicaid coverage extended through the first seven months of Wendy's life, until Herrera decided to return to Progreso, Guatemala, to care for her ailing mother.

There, Herrera ran a dressmaking business out of her own home and worked part time in a beauty salon. For eight years, Herrera supported her parents, her daughter and teenage brother.

Leslie Herrera began dating Julian Herrera while she was living in Guatemala. He had lived in the United States 14 years, first in California and then in Georgia, but came back to Progreso every three to four months to visit his relatives.

In 2000, Leslie returned to the U.S. on a travel visa, which would have allowed her to stay in the country for a year. She came here to work, and soon landed a job as a housekeeper in a nursing home in Ontario, Calif. She and Julian kept in touch through letters and phone calls. Last March, he invited Wendy and her to move to Gwinnett County. Leslie and Julian were married within the month.

The family moved to the basement bedroom in a cramped, two-story house shared by three Latino families in Norcross.

Inside, a lace curtain separates their queen-size bed, mini-fridge and bookcases from the area that serves as the living room, dining room and Wendy's bedroom.

A birdcage and a small TV sit on top of a covered bookcase, so both can be watched from the bed. On the opposite side of the curtain, a bottle of Sprite, bananas, an orange and saltine crackers — donations from the Herreras' church — sit on an oval mahogany table next to a row of Wendy's Barbie dolls.

Julian Herrera, who has a degree in mechanics, earns $300 a week loading and unloading other people's computers and antique furniture for Vintage Transport Services Inc. Leslie Herrera used to make $7 an hour cleaning houses in Gwinnett — a portion of which she sent home to Guatemala every month. But in January, when she told her boss she was pregnant, she was told to stop working.

Still, she thought she'd be able to pay for prenatal care with Medicaid. After all, Julian Herrera's green card made him eligible, and Medicaid had paid for Leslie's care in her first pregnancy. But when she went to apply, she was rejected.

In the last decade, the U.S. government's stance toward immigrants has changed. In 1994, voters in California attempted to eliminate public education and health care for undocumented aliens. Two years later, Congress passed a welfare reform bill that barred both recent immigrants and undocumented aliens from receiving Medicaid.

But if Congress was looking to save tax dollars, eliminating prenatal care for immigrants was a shortsighted way to do it. Prenatal care long has proven to reduce infant diseases and mortality. Without it, experts say, babies are at a greater risk for weight problems, sexually transmitted diseases and infections. And because the children of immigrants are American citizens, Medicaid (read: taxpayers) gets saddled with the costs when poor first-generation Americans are born sick.

Some states decided to continue funding prenatal care for undocumented aliens after the federal government withdrew its support. But Georgia's program hasn't kept up with the increased demands of an immigrant population that has exploded in recent years.

The state Department of Human Resources' Babies Born Healthy program was established in 1973 to help reduce Georgia's soaring infant mortality. The program's only requirement is that a woman be uninsured, not qualify for Medicaid, and earn no more than 250 percent of the federal poverty guideline.

But since Medicaid dropped undocumented aliens, Babies Born Healthy has been increasingly overwhelmed. The number of women in need of care grows by at least 5 percent annually, says program director JoAnn Smith, adding that about half the women now enrolled in the program are Latinos. Last year, Babies Born Healthy served 2,800 women statewide, but at least 1,800 expectant mothers were denied services after the funding dried up. In Gwinnett, where the Latino population multiplied eight times during the 1990s, the program ran out of money in the first six months of this fiscal year. In February, 50 women were on Gwinnett's waiting list for the program.

Despite the growing demand, Babies Born Healthy's budget is lower today, at $2.1 million, than it was in 1997. Last year, the General Assembly boosted the program by $634,000 for the last three months of the 2001 fiscal year, which ended last July. But a move this year to do the same thing is being opposed by the governor, who wants the program's annual budget to stay at $2.1 million through 2003. Although Barnes' office didn't return calls seeking comment, things don't look promising for the program. Last week, Sen. George Hooks, the Democratic chairman of the powerful Appropriations committee, said diverting money to a program like Babies Born Healthy is, given other obligations, "admirable, but not responsible."

Leslie Herrera learned about Babies Born Healthy, but soon found out she couldn't sign up because the program in Gwinnett had run out of funds.

The Herreras didn't know how they would pay for a doctor on their own. Julian pays $350 a month for rent and $540 in child support for two daughters he fathered in California. The family spends about $50 to $70 a week on groceries. On Julian's salary, that leaves them with at most $110 a month to cover other expenses — like prenatal care.

But when the expectant mother's vomiting worsened three weeks ago, the Herreras became desperate for medical care. Leslie Herrera decided the most affordable was the Grady Healthy Baby plan.

In mid-February, she went to a Grady clinic and paid $150 for initial lab work. She'll owe another $850 to complete her prenatal care, payable in installments. The clinic took samples of her blood and urine, but she has to wait until this week to visit a physician.

To earn extra money, Julian Herrera has been fixing cars nights and weekends. He has customers as far away as Athens. If he's lucky and the weather holds, he can make $100-$200 a weekend. Leslie Herrera hopes that by the time she is in her ninth month and seeing the doctor on a weekly basis, they will have paid off the bill.

But Leslie Herrera hasn't sent a check to her family in Guatemala since January. A Christian organization called the Pregnancy Resource Center of Gwinnett has given her clothes, food and blankets and other supplies for the baby.

She's waiting for her health to improve before she looks for work again.

"Right now [I'm not working] until the doctor sees me," she says, "because I don't know what he's going to tell me."