Lamar University nurse, Nicole Schroeder, may soon see her concern translate into a piece of Texas legislation.

A Lamar Nursing Alumni and a current nursing student in the university’s graduate nursing program, Nicole Schroeder, was tasked with presenting a healthcare issue to her state representative, along with a possible

solution. Under the direction of Dr. Iva Hall, Schroeder presented her concern titled “Transportation for Postpartum Women,” to State Rep. Dade Phelan. Phelan, a republican representing the 21st district, embraced the issue, proposed it as HB 1576, and Schroeder found herself before a legislative committee in March advocating for her schoolwork to become law.

“I presented my issue to Dade Phelan. He was very receptive and asked me to email my legislative summary to him, and he would gather more information,” said Schroeder. “I did, and honestly, thought that would be the end of our interaction. To my surprise, I received an email from his office asking me to attend the legislative hearing at the Capitol.”

Schroeder’s “Healthcare Policy and Finance” homework turned legislative initiative addresses a problem she witnessed working with a Nurse-Family Partnership (NFP) in Port Arthur. The evidenced-based program for low-income, first-time mothers sought to enhance maternal-child attachment and decrease subsequent pregnancies. Despite its efforts, the local NFP site reported an increase in repeated pregnancy rates over a four-year period as high as 39% during some years. When the clients were surveyed, the resounding explanation given was poor access to care due to transportation issues.

Schroeder suggested a solution to the problem – monies allocated for non-emergency medical transportation specifically for these clients. In HB 1576 Phelan takes Schroeder’s solution one step further, suggesting the use of “transportation network companies,” like Uber and Lyft, to help meet the needs of not only postpartum medicaid patients, but other medicaid recipients, as well. When proposed in mid-March, HB 1576 had more signatures of support (126) than any other bill up for consideration in the Texas House of Representatives. Phelan cited current research showing the proposed solution could result in a 34 percent decrease in cost to the medicaid system. According to a report in the March edition of the American Journal of Public Health, if Phelan’s idea was scaled nationally the savings could reach $537 million annually while decreasing no-show appointments by as much as 50%. He also stated those opposed to the bill had a financial stake in the current broken system but he was only concerned with better outcomes for patients and taxpayers.

“He proceeded to talk about how it is nurses who work in the trenches and know more than any legislator what is needed to change health outcomes,” said Schroeder. “I was excited, scared, and honored to get to tell the story of our clients that may lead to a solution.”

Schroeder was one of eight to testify in support of the HB 1576 and was given three minutes to make her point. (Her statement is below.)

“My takeaway was that nurses are passionate about their patients and are the best advocates for healthcare change,” said Schroeder. “Many of us shared personal stories from our patients and the committee was very receptive.” 

Nicole Schroeder’s Statement to the Health and Human Services Committee

Good Afternoon. I would like to thank Chairman Franks, the committee, and Representative Phelan for the opportunity to be here today.

My name is Nicole Schroeder. I am a Bachelor’s prepared registered nurse and a graduate nursing student at Lamar University in Beaumont, TX. I am here representing myself and testifying in support of HB1576.

My role as a nurse working with medicaid patients places me on the front line to witness the many struggles this population has to overcome in an attempt to access health care. We have done well in providing this population access to coverage. Unfortunately, access to coverage does not always translate into access to care.

Part of my job is to offer education and support to young women entering motherhood for the first time. I also encourage behaviors that create strong attachments with their children and support their own self-efficacy. Creating a stronger future for these families can only go as far as their ability to overcome certain obstacles in their life.

For the last 5 years, I have been witness to the many hurdles they must overcome to access the healthcare system and the resounding impact it has on their future and the generations that follow. This hurdle is their inability to access adequate and timely medical transportation to and from their doctor visits.

If you would grant me another minute or two of your time, I would like to share a few short stories straight from my patients.

My first patient is a 31-year-old female with a long-standing history of depression. She came to me during her first pregnancy. She receives housing and faithfully depends on our public transportation system to get her to and from her appointments. Following the birth of her child, her depressive symptoms worsened. Her depression, coupled with her new role as a mom and her dependence on a fragmented transportation system, led to poor follow through with her postpartum and mental health visits. My patient stated to me “what would take me 12 minutes from my house to the doctor, takes more than 2 hours one way because of all the extra stops and bus changes. It’s much too difficult to do with a small child, especially if there is bad weather.” Since giving me this statement 8 months ago, she became pregnant again for failure to receive birth control, blessed an adoptive family with the opportunity to care this child physically, emotionally, and financially, and has refocused her attention to her first child who receives social security disability due to developmental delays.

The second young lady was 17-years-old and pregnant when I received her on my caseload. She was dependent on family members and friends for transportation. The current transportation system will provide gas reimbursement for non-emergent visits to medicaid recipients; however, there is a lengthy verification process that only occurs after the patient’s appointment. My patient tells me “people need gas money now, not 2-3 weeks from now.” She now has 2 children for failure to attend her postpartum appointments regularly and receive birth control and struggling to finish high school.

My last patient I would like to share with you is a 20-year-old devoted breastfeeding mom who struggles with navigating the loopholes in medicaid transportation. The current system will provide a medical van to and from doctors’ appointments with a 48-hour notice, which means this mom could receive follow up care after delivery. Unfortunately, this system will not transport the newborn with mom because it is not a covered service under mom’s plan. This young lady was forced to make the decision to continue breastfeeding or receive follow up care. She chose to stay with her child and ensure breastfeeding was established. Her health took a back seat to her child’s needs. She became pregnant again and has been unable to return to college to complete her nursing degree.

These are just a few of the many stories I have been witness to during my career as a nurse, but enough evidence to support a change in a fragmented system. Forty-seven percent of my new moms express difficulty in accessing reliable transportation to and from their doctors’ appointments. As I have just shared, our current system leads to poor follow up, inconsistent care, repeated pregnancies, and untreated mental health disorders. Our families, our communities, and our nation are paying the price. The cycle of poor health outcomes will continue as long as the obstacles continue to be insurmountable. I feel that house bill 1576 is a step in the right direction and I am asking the support of the committee as well.

Again, I would like to thank the committee and Rep. Phelan for the opportunity to share my concerns, but most importantly, to be a voice for my patients. Thank you. I am open for questions.