U.S. Sen. Ron Wyden, D-Oregon, is co-sponsoring a bill intended to help small, rural hospitals in Northeastern Oregon and across the state and nation continue to deliver babies.

Wyden’s Keeping Obstetrics Local Act was prompted by the spread of “maternity deserts” as more rural hospitals close their maternity departments.

The list includes Saint Alphonsus Medical Center-Baker City, which closed its birthing center in August 2023.

According to a summary of the bill that Wyden unveiled during a press briefing June 17, a total of 267 rural hospitals — about 25% of the nation’s roster — closed their maternity departments 2011-21.

About 8 million women of child-bearing age live in counties without a hospital that delivers babies, according to Wyden’s office. More than 60% of maternity deserts are in rural counties.

Wyden, Oregon’s senior senator, described the trend as an “epidemic.”

He said maternity services are “essential,” particularly in relatively remote towns where the nearest other hospital can be more than an hour’s drive.

“We can’t just sit by and let these communities become sacrifice zones,” Wyden said.

A key part of the bill, which has 15 co-sponsors, all Democrats, is boosting federal payments to rural hospitals for maternity services. The legislation would increase Medicaid payments for some hospitals and add supplemental federal aid for hospitals that had an annual average of fewer than 300 births over the previous three years. The amounts of the federal aid would depend on the hospital and its circumstances, according to Wyden’s office.

The bill’s payments to hospitals with relatively low birth numbers would benefit at least three hospitals in the region based on statistics compiled by the Oregon Health Authority — Grande Ronde in La Grande (average of 250 births per year 2021-23), Wallowa Memorial in Enterprise (43 births in 2023, an average year), and Blue Mountain in John Day (average of 34 births).

And were Saint Alphonsus to reopen the maternity center in Baker City, it, too, would qualify, with an average of 86 births per year (the birthing center was closed for the final four months of 2023; the total for 2022 was 100 births, and for 2021 it was 112).

Hospitals that received federal money due to their low numbers of births would be required to use the dollars locally, and would have to repay the money if the hospital closed its labor or delivery units within two years of receiving the money.

Good Shepherd Hospital in Hermiston and CHI St. Anthony Hospital in Pendleton have averaged more than 300 births per year the past three years — 385 per year at Good Shepherd and 334 at CHI St. Anthony.

But those hospitals could potentially benefit from other forms of federal financial aid included in the Keeping Obstetrics Local Act.

Dan Grigg, CEO of Wallowa Memorial Hospital in Enterprise, called the draft legislation “an important step towards protecting access to maternity care in rural Oregon and across the country. 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. Senator Wyden cares deeply and understands the important role hospitals play in rural maternal health. We are grateful to have his support during this critical time.”

Grigg said the bill’s proposed low-volume adjustment in Medicaid rates to hospitals with fewer than 300 births could mean an additional $52,000 for Wallowa Memorial. And the supplemental federal aid to the hospital could amount to roughly $2.5 million, he said.

Grigg said the hospital’s obstetrics unit is not covering its costs, although Wallowa Memorial as a whole is on track to end the fiscal year in the black.

He noted that hospitals with a larger volume of births have an easier time covering the fixed costs in obstetrics departments — but those fixed costs don’t decrease that much in hospitals with fewer births.

And he added that it was important to the hospital’s leadership to keep the obstetrics department at Wallowa Memorial open if at all possible.

“It’s an hour-and-an-half drive to La Grande,” he said. “And so I think we would do all that we can to keep OB. It’s important to have this service for people.”

CHI St. Anthony Hospital President Harold Geller said the Pendleton hospital backs Wyden’s proposal. Geller noted some key facts about hospitals and births:

• 55% of rural hospitals no longer offer labor and delivery services.

• 267 rural hospitals stopped providing obstetrical care between 2011 and 2021.

• Medicaid pays for more than 50% of rural births with reimbursement at less than the cost of care.

“We also need the federal government to encourage state Medicaid agencies to develop Medicaid graduate medical education programs to specifically target rural hospitals that provide maternity care,” Geller said. “Funds could be used to provide labor and delivery certification or training for both OB/GYN physicians and non-OB/GYN clinicians, such as family practice physicians, nurse practitioners, midwives, doulas and community health workers who are willing to work in rural areas.”

Wyden’s proposal has been endorsed by the American College of Nurse-Midwives, America’s Essential Hospitals, Catholic Hospital Association, Community Catalyst, Families USA, Hospital Association of Oregon, National Partnership for Women & Families, National Rural Health Association, and the Oregon Perinatal Collaborative.

A summary of the bill discusses factors contributing to the wave of maternity center closures, what Wyden described as “stark economic realities.”

“The epidemic of hospital closures of maternity centers is produced by several overlapping challenges, including the high fixed operating costs of these units, low volumes of births, and difficulties in attracting and retaining OB-trained clinic staff, all of which is exacerbated by inadequate reimbursement for labor and delivery services,” the summary states.

The summary also notes the widespread closures of maternity departments coincides with a rising maternal mortality rate in the U.S. That rate is 21.1 deaths per 100,000 live births, seven to 10 times higher than in many other wealthy countries.

In addition to increasing federal payments to eligible hospitals, the Keeping Obstetrics Local Act would:

• Require 12-month continuous coverage with full benefits, under Medicaid and CHIP (Children’s Health Insurance Program, a joint federal-state program), for pregnant and postpartum women.

• Instructs the Health and Human Services secretary to “issue guidance for supporting and improving access to coverage of and payment to doulas, certified midwives, and other maternal health professionals in rural areas.”

• Increases Medicaid and CHIP financial support for depression and anxiety screening for women before and after birth.

• Establishes new authority for the HHS secretary to deploy obstetrics-trained providers from the Commissioned Corps of the U.S. Public Health Service to hospitals and states with urgent maternal care needs. This section of the bill authorizes $150 million in annual funding for the Commissioned Corps.

• Requires state Medicaid programs, such as the Oregon Health Plan, to simplify the process for out-of-state obstetrics providers, such as nurses, to enroll as Medicaid providers for five years.

• Requires hospitals planning to close the obstetrics unit to submit a report to local, state and federal agencies, at least 90 days prior to closure, that analyzes how the closure will affect the community, including projected adverse health outcomes and increased costs.