A simple "thank you for your comment" might have sufficed.
But Rep. John Dougall, R-Highland, felt compelled to say a bit more in response to the retired professor and midwife who asked him to "work hard" to preserve Medicaid coverage for thousands of pregnant women.
"Your advocacy of a culture of irresponsibility and taxpayer dependence is noted," said Dougall in a Feb. 24 e-mail to Joyce Foster.
While atypical in tone, the sentiment is not uncommon on Capitol Hill, say advocates who, nearly every year, find themselves battling to protect state-sponsored health coverage for Utah's poor and disabled.
Still, the missive "stunned" Foster, who had been moved to write Dougall as a witness to the benefits of prenatal care. "His reply was just terrible," said the 73-year-old. "I would think it would be political suicide for anyone to be that rude."
Lincoln Nehring, a policy analyst with the Utah Health Policy Project, said it's "very telling" that Republican leaders appointed Dougall chairman of the Health and Human Services budget committee.
"His views about public programs and Utahns who use them are no secret, clearly, and leadership saw fit to give him great power over these programs' budgets," said Nehring.
Entrenched in Utah's culture of individualism, stereotypes about the poor can be hard to shake. Some believe poverty is a lifestyle by choice, advocates say.
"A lot of lawmakers think that if the poor just got a job, they'd be fine. That's changed a little with the recession, as they see people in their neighborhoods being laid off," said Linda Hilton at Crossroads Urban Center. "But few take the time to learn about people's circumstances."
In an era when formerly middle class families are flooding food pantries and signing up for food stamps, Dougall's attitude reminds advocates they need to continue to educate Utah's lawmakers, they said. Rather than joining a culture of dependence, many people use government benefits for a short period of time.
"People on Medicaid don't drive BMWs," said Heather Tritten, the executive director of the Community Action Partnership of Utah. "The reality is most people -- who are on Medicaid because they're pregnant -- are working very hard to survive."
Dougall contends his comments weren't meant to disparage the poor. To the contrary, he said, they were aimed at pregnant college students who use Medicaid to pay for their prenatal care and deliveries despite having assets or access to assets.
Among the proposed cuts to Medicaid this year are those targeting an estimated 5,600 pregnant women who qualify as low-income, but have to spend down their assets by paying a portion of their medical bills.
The impetus for the proposed cuts, as discussed in committees: rumored scores of Brigham Young University students on Medicaid.
It's "an apocryphal story" that legislators on both sides of the aisle have latched onto, said Korey Capozza, senior health policy analyst at Voices for Utah Children. "We have no evidence, apart from unsubstantiated anecdotes, that any wealthy pregnant women are abusing the Medicaid program."
There is nothing to prove it doesn't happen, either. Health officials haven't studied the matter. And there's no way to tell using existing data, said Michael Hales, Utah's Medicaid director. Information on whether Medicaid applicants are students isn't routinely collected because it has no bearing on their approval.
Were it possible to prove abuse, it likely isn't widespread: At a time of unprecedented growth for Medicaid, enrollment of pregnant women has been flat, Hales said.
Regardless, Dougall finds it unsettling that young women with the means to pay college tuition somehow can't afford health coverage.
"Since pregnancy is a planned event, in all but the rarest of occasions there is typically adequate time for financial planning before and during a pregnancy," Dougall said.
Advocates argue the cost to taxpayers of poor birth outcomes and the tragedy that can follow for families from diminished access to prenatal care should unsettle lawmakers more.
Unplanned pregnancies are frighteningly common, especially in cultures that frown on birth control, said Kimberly Hall, director of the University of Utah's Women's Resource Center, which counsels teen mothers.
"Sex education isn't permitted in schools, so we leave it to parents and then punish the girls who become pregnant out of wedlock," said Hall. "It's like saying, 'Here's the river. We're not going to give you a boat. We're not going to give you oars. But we expect you to get down it.'"
Foster recalls a time, before prevention efforts such as the state's Baby Your Baby program, when newborns were hospitalized for maladies as avoidable as malnutrition.
When you pay for prenatal care, babies are fatter and healthier, said Foster. "A lot of the women just didn't know what to eat or how much."
Denying women this type of care because they're deemed "undeserving," would set Utah back 30 years, Foster said.
