Health Reform’s Maternity Coverage – Best Gift an Expectant Mother Could Receive – Say Ahhh! A Children’s Health Policy Blog

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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.

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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.

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