Another bus stopped on Greenbelt Road and a few more women, wilting from the heat, arrived at the Pregnancy Aid Center.
They settled heavily into worn chairs in the small, scuffed waiting room, decorated with many, many snapshots of babies: black, white, Asian, Hispanic -- like the pregnant women who go there. Many of the patients are poor legal immigrants, women who work in nursing homes or clean offices or are married to mechanics or laborers. Many rely on Maryland state health insurance, or Medicaid, for their prenatal care.
But for the state's most recent immigrants, the days of state-paid health care are quickly drawing to a close, according to a small typed sign taped to the clinic wall.
In the state budget that took effect this month, Gov. Robert L. Ehrlich Jr. (R) eliminated $7 million for the coverage of about 4,000 pregnant women and children who have been classified as permanent legal residents for less than five years.
Last week, he restored $1.5 million for prenatal services, expected to be enough to care for women already in the system. Starting July 1, pregnancy center staff members started counseling many parents not to think about another baby anytime soon.
"I'm sick to my stomach," clinic director Mary Jelacic said.
Some hospital officials share her dismay. At Children's Hospital, for instance, officials said they expect little compensation for the uninsured immigrant children from Maryland they are treating.
Some lawmakers are questioning whether, in light of Maryland's newly announced $1 billion surplus, the state should do more. In a hearing in Annapolis yesterday, they argued that immigrant children could end up relying upon emergency rooms for care. And without proper prenatal care, mothers and newborns could suffer lasting consequences.
"Prenatal care is crucial," said state Sen. Gloria G. Lawlah (D-Prince George's), who chairs the subcommittee that hosted the hearing. "We can affect the long-term health of those embryos. . . . Those babies are going to be American citizens."
Ehrlich administration officials say the Medicaid cuts are essential to containing the cost of the insurance program, which accounts for about one-fifth of the state's general fund. The move should not be seen as anti-immigrant, said state Health Secretary S. Anthony McCann.
"It's consistent with federal law," he said. Immigrants, he added, have options other low-income residents don't. "The fact is, they have sponsors," McCann said. "They have alternatives."
The state has boosted funding for community health centers and will be working with public health departments in Montgomery and Prince George's counties, home to most of the immigrants who will be affected, he said.
Maryland's decision echoes the debate over the nation's 1996 Welfare Reform Act, which made most legal immigrants ineligible for federal programs and cash assistance during their first five years here.
The District and more than 20 states, including Maryland and Virginia, restored heath care coverage to at least some of those immigrants, according to a study last year by the Kaiser Commission on Medicaid and the Uninsured.
In the District, more than 800 children, including recent immigrants, are covered in a program paid for by the city. Adults are eligible under another locally funded program. Virginia covers qualified immigrant children, as well.
At the Pregnancy Aid Center in College Park, the Medicaid cuts are only the latest in a series of setbacks, which have included reductions in the county's health budget, a freeze in family planning funds and the loss of an infant mortality grant.
"We thought it was bad before, but this is worse," Jelacic said. "How do we survive?''
Now her staff checks each new patient's green card to see if she qualifies for Medicaid benefits.
"If we don't keep the balance, we'll be able to see no one," Jelacic said. "If we can't pay our physician, we'll have to shut down.''
Marion Kamara, 20, a nursing assistant who emigrated at 16 from Sierra Leone, is luckier than some. Since she already is receiving care for her pregnancy, she will get Medicaid until two months after she delivers. Kamara, dressed in a long, colorful tunic and head wrap, sat in Jelacic's small office, trying to understand the new policy.
"Your baby will be eligible," Jelacic offered. "He is an American."
Kamara slowly mulled the words. "So," she said quietly, "I'm not American."