Health Reform's Maternity Coverage - Best Gift an Expectant Mother Could Receive

By Amanda Jezek, March of Dimes

Health reform is giving pregnant women throughout the U.S. a far more valuable package than anything they could ever unwrap at a baby shower -- access to maternity coverage.

Coverage for maternity care is crucial because, without it, women face much more difficulty in obtaining needed health services.  Women who have insurance coverage for maternity care are more likely to receive screening and diagnostic tests that can help to identify problems; services to manage developing and existing problems; and education, counseling, and referral to reduce risky behaviors like substance abuse and poor nutrition.

Prenatal care can help reduce infant mortality and improve birth outcomes; postpartum care can help women appropriately space pregnancies, which can reduce the risk of preterm birth.

According to U.S. Census data prepared for the March of Dimes, a whopping one in five women of childbearing age is uninsured. Now consider that 50 percent of pregnancies are unplanned. Those who tried to get coverage on the open market were in for a rude awakening: insurers considered pregnancy to be a pre-existing condition and would therefore often deny coverage.  Needless to say, many women found themselves facing this dilemma.

Consider a March of Dimes family in Virginia who signed up for private insurance because their COBRA coverage from a previous job was about to end. They took the precautionary step of adding a maternity rider, which had a six-month waiting period before covering pregnancies. They didn't think there would be any issue as they used fertility treatments to conceive their first child. Despite being told by doctors that they had only a five percent chance of getting pregnant naturally, four months into the six-month waiting period, they discovered they were expecting. At that point, no other insurance company would pick-up coverage determining that the pregnancy was "a pre-existing condition." It cost the family $20,000 out-of-pocket.

Thanks to health reform, the practice of pre-existing condition exclusions will be prohibited in 2014 (earlier for children).  But the pre-existing condition exclusion was only one of many hurdles that pregnant women faced to obtaining coverage -- and that health reform will fix. 

In 2006, a Georgetown University study commissioned by the March of Dimes found that 19 states had adopted laws to require coverage of maternity care. However, these laws varied in scope, and only five of the states (MA, MT, NJ, OR and WA) required all insurers in the individual market to cover maternity care. In states without such requirements, maternity coverage is typically available only through an expensive rider to the underlying policy -- and then with a waiting period or outright denial if the woman is already pregnant.

Health reform will require insurers to cover an essential benefits package that includes maternity care.  Insurers will no longer be able to exclude this critical benefit from policies.

While these private insurance reforms are a tremendous step forward, over 40 percent of pregnant women rely on Medicaid for their coverage.  Health reform makes improvements for these pregnant women too.  Beginning in 2011, all state Medicaid programs will be required to cover tobacco cessation counseling and pharmaceuticals for pregnant women. Given that pregnant women in Medicaid are 2.5 times more likely than other pregnant women to smoke and that smoking dramatically increases the risk for numerous poor birth outcomes (such as preterm birth and low birth weight), this policy will provide much needed assistance to millions of pregnant women.  The U.S. Preventive Services Task Force has found that tobacco cessation interventions are very successful in helping pregnant women quit, and these services have even been found to save money.

Health reform also gives states the option to start covering more low-income women before they get pregnant using Medicaid family planning expansions.  States previously needed a waiver to extend this coverage, but now they may use a simple state plan amendment.  In addition to appropriately spacing pregnancies, women whose pregnancies are planned are more likely to begin prenatal care early, increasing the likelihood of a healthy birth.  And Medicaid family planning expansions have been found to save money at both the state and federal levels.

The daunting task of implementation awaits, but women throughout the country can at least be assured that when they become pregnant, they will have coverage for maternity care to help provide their children with the healthy start they deserve.

Editor's Note: The views expressed by Guest Bloggers do not necessarily reflect the views of the Center for Children and Families. The photo of the mother and baby was provided by the March of Dimes Foundation and may not be reprinted without that organization's permission.