Coverage for Pregnancy, Maternity & Newborn Care May Soon Become Optional

pregnant woman at work

We already knew that a repeal of the Affordable Care Act (ACA) would likely result in restricted access to birth control and fewer choices in women's health care overall (at a greater expense), but things are looking bleaker than ever: Seema Verma, Trump's pick to run the Centers for Medicare & Medicaid Services, said at her confirmation hearing last week that pregnancy, maternity, and newborn coverage should be optional in plans.


As any parent knows, the medical costs associated with having a child are stratospherically high: According to a report by Truven Health Analytics that looked at data from 2004 to 2011, the average total price for pregnancy and newborn care was about $30,000 for a vaginal delivery (and a whopping $50,000 for a C-section). And, before Obamacare, only 12 percent of the health policies available on the individual market (meaning non-employer-based insurance) offered maternity benefits, according to research by the National Women's Law Center -- and those weren't necessarily all that great. Women were often charged extra for maternity coverage and subjected to waiting periods of over a year.

The ACA changed that by making it illegal to deny women maternity care and also by forcing insurance companies to charge women and men the same prices for comparable coverage. Under the ACA's least expensive plan, out-of-pocket maternity costs were capped at $7,150 (in 2017).

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But if Verma -- and like-minded Republicans -- get their way, all of that could go away. Verma supports making maternity care optional based on the idea that people like men and older women shouldn't have to pay for coverage they're not going to use. Which sounds reasonable for about a split second, until you realize that women would still be expected to pay for coverage they're not going to use. Linda Blumberg, senior fellow at the Health Policy Center at the Urban Institute, used the following example: Women don't need prostate cancer screening, but they pay for the coverage anyway. 

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What Verma is proposing gives patients the illusion of choice, but if providers aren't required by law to cover pregnancy, maternity, and newborn care -- or prevented from jacking up the costs -- low-income women in particular will be left with little to no choice at all. And there are plenty of types of other services at risk of being drastically reduced, too.

The ACA required insurers to provide at least "10 essential benefits" including emergency care coverage and hospitalization. While it's (hopefully) unlikely that these benefits would disappear entirely under the GOP's new plan, among those that we can expect to be considerably weakened are pediatric oral and vision care, prescription drugs, preventive and wellness services, chronic disease management, and mental health and substance abuse services. (So, you know, pretty much all the things you want health insurance for to begin with.)

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While alarming, Verma's position does not come as a surprise. Previously, Verma worked with Mike Pence to transform Indiana's Medicaid program into the Healthy Indiana Plan (HIP 2.0), which requires low-income adults to contribute up to 2 percent of their income to a savings account for "enhanced" medical benefits like dental care. Those who are unable to contribute, however, are put in "basic" plans requiring co-pays for all services and offering fewer benefits -- or they're dropped from insurance altogether. Again, we're talking about the illusion of choice: For some low-income families, contributing 2 percent of their income is too great a financial burden to bear.

While mothers and mothers-to-be aren't the only people looking at an extremely uncertain health-care future, the stakes are particularly high for women -- so it's particularly frustrating that a woman would use her position of power to put others at risk. Thousands and thousands of vulnerable Americans are about to suffer devastating consequences as a result of her decisions. Something has to be done.

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