GOP healthcare bill may send pregnant women back to days without coverage
In 2011, when Corey Miller was getting ready to get married, she knew it wouldn’t be too long before she and her new husband would be ready to start a family. She made an offhand inquiry to her insurance company, and was floored to learn that her policy – which she purchased as an individual – wouldn’t offer her any maternity coverage.
So Miller shopped around. And in the entire state of Missouri, she found just one policy for individuals that offered maternity coverage – via a “rider” she could buy for an extra $100 a month. Miller would have to pay for the rider for 18 months before her maternity coverage kicked in, and then keep paying for as long as she wanted to maintain the extra coverage.
“I was shocked,” said Miller. “There were not options in the state of Missouri. And if you wanted to have maternity coverage, you were paying a serious amount of money.”
Six years later, the Affordable Care Act has transformed maternity coverage – and made expensive add-ons like these a thing of the past.
The law, known as Obamacare, required all health insurance plans sold to individuals to cover maternity care as one of ten “essential health benefits”. Another category, preventive care, covers a wealth of pre- and postnatal services, such as prenatal check-ups and breastfeeding support. The law also eliminated lifetime and annual caps on healthcare spending, giving a financial reprieve to thousands of women with expensive pregnancies.
But those benefits are on the chopping block now that Republicans in Congress are racing to repeal major portions of the ACA. The Senate bill revealed last week and the measure that passed House in May would both allow states to seek waivers letting insurers drop the essential benefits to keep down costs.
Few benefits seem more vulnerable than maternity coverage. In a nonpartisan evaluation of the House bill, the Congressional Budget Office predicted that maternity coverage, along with mental health care, would be the first benefit many insurers would eliminate in their individual market plans. (Twelve states require the coverage independent of the ACA.)
That would leave an untold number of women without coverage in a country where the price of giving birth usually exceeds $10,000 if paid out of pocket.
“You’re looking at women suddenly facing soaring costs for extra coverage, if they can even get it,” said Usha Ranji, the associate director for women’s health policy at the Henry J Kaiser Family Foundation. “Big picture, having a baby is the most common reason for hospitalization in this country. This is a very common event we’re talking about not covering.”
The maternity care requirement was meant to address an alarming disparity affecting women who purchase their own healthcare.
Poor women have increased eligibility for Medicaid while they are pregnant, and the Pregnancy Discrimination Act of 1978 requires maternity coverage in most employer-provided healthcare plans. But until 2014, healthcare plans sold to individuals weren’t required to offer maternity coverage.
That left thousands upon thousands of women without coverage for a pregnancy. In 2013, three-quarters of all insurance policies available to individuals didn’t offer any coverage of delivery and inpatient maternity care. Women with these plans would either have to purchase a rider if they got pregnant – at a cost of up to $1,000 a month – or pay many times that out-of-pocket.
Miller credits the ACA with allowing her to get pregnant and give birth to her daughter “without bankrupting my family”.
The maternity coverage provision is not all that’s at stake. The Senate bill to repeal the ACA would also permit states to seek waivers for lifetime and annual caps on health insurance spending, something Obamacare eliminated. With childbirth being so expensive in the US, some women and families will easily blow through a cap on their coverage.
Congress is also weighing waivers for preventive services, which provided prenatal screenings and postnatal care without a copay.
Eliminating some of the essential health benefits, Republicans argue, would allow insurers to sell insurance at a lower cost and with greater flexibility. And they have repeatedly pointed to maternity care as something not everyone should have to purchase.
“[A] single male, age 32, does not need maternity coverage,” Representative Renee Ellmers fumed in a 2013 hearing in the House. Representative Rod Blum echoed her this year, saying the ACA had created “crazy” situations, like “a 62-year-old male having to have pregnancy insurance”.
But the effect of singling out maternity coverage is that the cost of childbirth is shifted entirely onto individual pregnant women and their families – something lawmakers are not openly advocating for conditions like cancer or heart disease.
“It is singled out, and I don’t get it,” said Ranji. “Everyone is born. But it is part of a set of women’s health services that get singled out more than other forms of health care,” such as contraception coverage. She noted that a majority of the US public is in favor of requiring insurers to cover maternity care, even after hearing Republicans’ arguments.
‘These outside forces were deciding when we would have kids’
Maternity coverage wasn’t perfect under the Affordable Care Act. The law never explicitly stated which services insurance policies were obligated to cover, or prevented insurance companies from imposing expensive out-of-pocket costs. And many insurers refused to extend maternity care to adult children who stayed on their parents’ plan.
But it made sure there weren’t surprises like this one: When Natalie Burg, of Michigan, was newly married, she discovered that adding a rider for maternity coverage would more than double the cost of her health insurance, from $120 a month to more than $300.
She and her husband weren’t planning on having children right away. But they planned on starting a family before too long, and an accidental pregnancy was always a possibility.
“We really went back and forth,” Burg said. “Do we rearrange our budget? Do we have $200 a month to spend as a what-if cost?”
Burg never added the rider. It turned out her insurance company only permitted her to purchase one rider per year – another method of keeping costs down – and she had already added a rider for dental coverage.
Instead, she and her husband did everything in their power to keep her from getting pregnant. It became frustrating once they became ready to start a family.
“These outside forces were deciding when we would have kids,” Burg recalled. “We probably would have started trying earlier than we did if it hadn’t been so completely off the table for us.”
Eventually, Burg and her husband got a new insurance plan, this one designed to meet the requirements of the Affordable Care Act. It offered maternity coverage without any extra hoops. Burg got pregnant two weeks into the start of her coverage.
“It would have been financially disastrous for us to have gotten pregnant any sooner,” Burg said. “[The] ACA took that restriction away.”