CBS recently aired a segment about the Affordable Care Act (ACA) and new requirements that insurance plans must cover maternity care. But instead of focusing on women who will benefit, CBS interviewed a man who does not want his family’s insurance to include maternity coverage because they no longer need these services.
Let’s set the record straight. Health insurance does not work like an a la carte menu. You don’t get to decide that you don’t want to cover diabetes care because you aren’t at risk for diabetes, but do feel like covering cancer treatment given that your mom had breast cancer. Instead, health coverage pools your premium payments and your health care risks with everyone else’s premiums and health care risks—and therefore protects you against the health costs you can predict and also the health costs you can’t predict. As for maternity care, the individual market is substantially improved by the Affordable Care Act. State and federal anti-discrimination protections insure that most women with employer-based health insurance receive maternity benefits. However, prior to the ACA, there were no federal requirements to provide maternity coverage in the individual insurance market.
Before the Affordable Care Act:
- Women face unfair and discriminatory insurance practices, such as being denied coverage or paying more for health insurance than men. At the same time, individual market health plans often exclude coverage for services that only women need like maternity care. In most states, women are routinely denied coverage because of pre-existing conditions such as being pregnant or having had a C-section, breast or cervical cancer, or receiving medical treatment for domestic or sexual violence.
- NWLC research found that the vast majority of individual market plans do not cover maternity care at all, while a limited number of insurers sell separate maternity coverage for an additional fee known as a “rider.” Maternity riders may include a waiting period (one or two years, for example) before the coverage even takes effect and the actual benefits provided through riders are often limited in scope.
- In states where it is not mandated, only 6% of the health plans provide maternity coverage. Even when states that mandate maternity coverage are included in the calculation, the number only reaches 12%.
After the Affordable Care Act:
- Many of the provisions of the Affordable Care Act reform the individual market—this is the portion of the insurance market that largely failed women by not providing coverage of maternity care or denying coverage to women based on “pre-existing conditions.”
- These reforms mean that all plans in this market, including those sold inside the recently launched Health Insurance Marketplaces, will be required to cover a specific set of services known as the Essential Health Benefits. These benefits include maternity and newborn care as well as ambulatory patient services; emergency services; hospitalization; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services (including contraception), and chronic disease management; and pediatric services, including oral and vision care. Access to maternity coverage is an important component to improving health outcomes for women and their babies.
The ACA marks a tremendous step forward to correct longstanding problems in women’s health insurance coverage, most notably in the individual market—by now requiring maternity coverage.