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The state health plan paid the medical bills for 52 percent of births in Arizona last year, a solid investment in public health. But the system has holes that, if fixed, could help reduce that number.

The Star's Jane Erikson reported that the Arizona Health Care Cost Containment System, or AHCCCS, paid for the delivery of 53,121 babies last year, which is slightly more than half of all births in Arizona. The state system paid an average of $4,200 per birth for a total of $223 million, which includes prenatal care for most of the mothers.

This investment, while large, is worthy and necessary. Good prenatal care helps ensure that babies are born healthy and that mothers-to-be receive proper medical attention. Erikson reports that studies have shown that every $1 spent on prenatal care saves at least $3 in medical bills for health problems that could have been headed off during pregnancy.

Such a rate of return is hard to beat, especially in a state where nearly two in 10 Arizonans don't have health insurance.

Arizona's public health coverage system has had to change over the years. In 1982, Arizona, which was the last state in the nation to sign on to Medicaid, began signing up AHCCCS members who earned no more than 33 percent of the federal poverty level. Voters approved increases in 1996 and 2000 that raised the income limit to meet the federal poverty level, which today is $20,000 for a family of four.

A proposal from state Sen. Barbara Leff, R-Paradise Valley, would increase the amount of money Arizonans could earn and still qualify for AHCCCS. Now, pregnant women can usually get into AHCCCS if they make within 133 percent of the federal poverty level — roughly $18,200 for a single woman.

Leff's proposal would increase that to 185 percent of the poverty level, but it appears Senate leaders have decided to go with an increase to 150 percent. The Legislature and Gov. Janet Napolitano must realize how vital this coverage is to our state and raise the income limit as high as possible.

Arizona families who earn too much to qualify for AHCCCS can receive coverage under KidsCare, which allows members to earn up to 200 percent of the poverty level — $40,000 for a family of four. More than 64,000 kids are enrolled but, according to Erikson's story, experts say another 100,000 are eligible.

Parents of children enrolled in KidsCare can receive coverage through KidsCare Parents, another public program.

Critics argue that families who can afford to pay for prenatal care and delivery on their own are skating by on taxpayer money. Darcy Olsen, president of the Goldwater Institute in Phoenix, told the Star that while few would argue with helping those who are truly indigent, the higher income levels allowed means Arizona taxpayers are footing the bill for families that should pay their own way. "Now they are helping families who are middle class," she said.

The reality today is that for many people, middle-class wages no longer cover the bills of what we think of as a middle-class life. We're talking about the basics of a healthy life, not the "need" for SUVs and a flat-screen television.

The cost of buying health insurance continues to increase — it went up about 13 percent in 2006 according to industry reports — and employees are being required by their employer to pay more for their monthly premiums. Some companies are also tacking on new fees, on top of premiums, for such things as adding a spouse to a health plan if the spouse has access to coverage through his or her job.

People who lose coverage often can't afford to buy individual coverage — or those who need coverage the most are excluded because of a pre-existing condition, like having survived cancer.

Boosting contraceptive coverage could help reduce the number of births taxpayers must cover. Arizona pays for birth control for low-income women, but only for women who already have a child and only for two years — rules that don't make sense. Helping more women prevent pregnancy is an obvious way to reduce the number of births covered by the state's health plan.

Arizona must increase the number of women and babies eligible for prenatal and delivery care by the public health plan, while at the same time making contraception more accessible, so fewer people have to use the system. Taking good care of Arizona's mothers and children is not an either-or proposition.