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Rachel Azanleko-Akouete: Ending Birth Cost Recovery Policies Will Help Lessen Racial Health Disparities

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Rachel Azanleko-Akouete

The most important factor in a child’s upbringing is whether the child is brought up in a loving, healthy, and supportive environment.

The ideal American family is comprised of a father, mother, and children. From a very tender age, these children have both parents present in their lives. They take them to school, pick them up from school, feed them good food, involve them in after school activities, read them books, take them on vacation. They also set up a college fund for them and coach them until they graduate from high school and college. Most of the time, kids who grow up in such environments already have jobs lined up for them after graduation. They may also inherit wealth, such as houses or real estate, by the time they are ready to start their own families.

That is the American dream that every parent wants for themselves and their children. Unfortunately, our society does not allow each one of us to have a taste of that ideal American dream. Most of us will achieve success and reach our full potential in life only if we have the right resources, and if we are given the same opportunity throughout life. Who we are and who we become is often determined by race and ethnicity, social-economic status, or/and gender, and most importantly, policies and practices that impose unnecessary barriers to thriving. That ideal American dream seems far more unreachable for many families in Wisconsin.

A recently published joint project of Policy Matters Ohio, titled  “Race in the Heartland,” reveals that Wisconsin has the regrettable distinction of ranking among the worst states in the nation for racial inequality. One of the policies that contribute to the persistent inequity in health in Wisconsin is the Birth Cost Recovery (BCR) policy.

BCR is a collection process directed by the State of Wisconsin and implemented by County Child Support Agencies (CSA) to pursue the recovery of Medicaid-supported birthing costs from unmarried, often non-custodial fathers. The repayment process is enforced by the CSA, set by a judge or court commissioner in family court, and linked to child support obligation payments. The obligated father is ordered to pay 85 percent of the amount of birth cost recovered to Medicaid, and 15 percent is given to CSA as an incentive to pursue BCR.

Between 2011 and 2016, Wisconsin collected nearly $106 million in BCR judgments from families that are struggling to make ends meet; $15,883,236 of the amount collected went to Child Support Agencies as an incentive and the remainder went to the state and federal governments. None of the funds collected from the identified father go back to the family. Wisconsin remains one of the few states to collect birth costs. Since the majority of fathers charged with BCR orders are lower-income come and fathers who are less likely to have private insurance, the harmful economic and child support compliance process of the BCR policy disproportionately affects lower-income mothers and children.

In addition, pregnant mothers who are aware of the BCR policy may delay applying for BadgerCare Plus for fear of revealing the father of their child and desire of maintaining stable relationships. Various health care professionals suspect that the BCR policy delays entry to prenatal care and contributes to stress. They recommend the repeal of the BCR policy as one of the multifaceted approaches to improve birth outcomes in Wisconsin.

Fortunately, for Dane County’s most vulnerable population, the BCR is one less stress to overcome.

County Executive Joe Parisi has ended the BCR practice in Dane County with his 2020 budget release. By ending the BCR in Dane County, Mr. Parisi has created a future that was not going to exist for families in Dane County who are more likely to be impacted by this policy. Most importantly, he has demonstrated his commitment to addressing disparities in birth outcomes in Dane County.

Dane County and Milwaukee County have been the two counties who aggressively collect BCR in Wisconsin. I urge Milwaukee County Executive Chris Abele to follow the footsteps of Mr. Parisi and end the BCR collection practice in Milwaukee County to improve birth outcomes and close the black/white infant mortality rates in Milwaukee County.