Despite early setbacks, millions of people have now enrolled in private insurance plans that meet new standards set by the Affordable Care Act. All of these policies must now cover a broad set of benefits, including prescription drugs, mental health treatment, and hospital stays. Still, one of the most common complaints about health reform is that insurers must now cover maternity care. Why, a middle-aged man will sometimes complain, should he have to buy a more expensive plan for a benefit he will never use? The requirement is about fairness, predictability, and normalizing medical care for pregnant women.
It is important to remember how insurance companies used to operate. Before the Affordable Care Act purchasing maternity coverage in the individual insurance market was a frightening and expensive proposition. Individual insurance plans rarely covered pregnancy. If you had insurance, even comprehensive insurance, you still had to purchase an entirely separate policy to cover the birth of your child. This was the case if you lived in North Carolina. In some states you could not purchase maternity coverage, even as an additional benefit.
Before reform you could not buy maternity coverage after getting pregnant. All too often couples would learn that their insurance plan did not cover the birth of a child after it was too late. They were then barred from purchasing a maternity policy at any price because pregnancy was considered a pre-existing condition. Couples with pricey plans were still forced to pay thousands out-of-pocket for the right to have a child.
For the lucky couples who realized that pregnancy was a pre-existing condition, purchasing coverage still presented challenges. Expecting parents sometimes had to pay $300 or $400 per month for maternity coverage in addition to their basic insurance plan. If it then took a year or two to get pregnant, which is not an uncommon occurrence, then couples could face $10,000 or more in insurance premiums before incurring out-of-pocket expenses for the birth. This arrangement was impractical and unfair. It was certainly not pro-life.
How did the Affordable Care Act change the treatment of maternity coverage? First, insurance companies can’t refuse coverage of pre-existing conditions. That means couples can purchase a policy during open enrollment periods even if they are already expecting. Second, pregnancy is no longer treated like a rare disease requiring unusual medical care. Instead, all insurance plans must cover maternity treatment and childbirth so that our federal health policy supports healthy children and families.
This requirement that we not target pregnant women does have consequences. If women could separate out the treatment of testicular cancer from their insurance policies then the plans would cost less. Similarly, mandating coverage for maternity care makes policies more comprehensive and pricier. The move to normalize pregnancy was also behind many of the insurance policy cancellations last year. Even after health reform passed some insurers continued selling policies that excluded maternity care. That meant these plans did not meet the minimum standards of health reform that took effect in 2014.
But in a few years it is likely that the grumblings over maternity coverage will fade and society will accept that we all benefit from the fair treatment of families. It is also likely that politicians will stop proposing that we turn back time by once again allowing insurance companies to carve out pregnancy as a pre-existing condition.
Adam Linker is a health policy analyst at the North Carolina Justice Center.