By: Dania Palanker, Senior CounselPosted on March 3, 2015 Issues: Health Care

Imagine an insurance market where only 12% of health insurance plans include maternity coverage. Imagine further that if a woman wanted to add maternity coverage, she would have to pay thousands of additional dollars each year and, even then, the insurance would not cover her pregnancy until she passed a one or two year waiting period. If a woman was pregnant when she applied for coverage or had a previous caesarian delivery, she could be denied health insurance.

It shouldn’t be too difficult to imagine, since this was the individual health insurance market in the United States just fifteen months ago.

When LaDonna Appelbaum became pregnant in 2010, she discovered that her health insurance did not cover maternity care — it did not cover any costs related to prenatal care, nor any related to her eventual miscarriage. When she searched for a new policy that would provide these benefits, she was told that she would have to endure a one-year waiting period for pregnancy coverage — and then her premiums would quadruple.

The individual health insurance market failed women like LaDonna before the passage of the Affordable Care Act. On Wednesday, March 4, the Supreme Court will hear a case that could bring those failures back.

If the Supreme Court rules in favor of the plaintiffs in King v. Burwell, then women — including pregnant women — who buy their coverage in 37 states’ health insurance Marketplaces could lose the federal subsidies that make health insurance affordable. At that point, the protections of the ACA could unravel, leaving pregnant women (and others) without coverage.

What does this mean for pregnant women? Hospitals charge an average of $32,093 for vaginal births and $51,125 for caesarian births [PDF] covered by insurance. A woman who does not have coverage or whose insurance does not cover maternity could be billed the entire amount. This means a new mother could leave the hospital with tens of thousands of dollars in medical bills for labor, delivery, and newborn care.

Now, imagine you become pregnant a few months from now. You have an expected delivery date early next year. You schedule prenatal visits and begin to work out a delivery plan with your provider. But what happens if you learn that you will lose your affordable health insurance? And you can’t even find coverage that covers your pregnancy? We don’t want to find out.