It was the kind of answer that sent chills down the spines of those of us who care about women’s health. At her confirmation hearing last week, President Trump’s nominee to lead the Centers for Medicare & Medicaid Services said she thinks it should once again be optional for health plans to cover maternity care. Responding to a question from Senator Debbie Stabenow (D-MI) of the Senate Finance Committee, Seema Verma indicated that she considers it acceptable for health plans to exclude maternity and newborn coverage — a significant shift from the guaranteed coverage that millions of families enjoy today, thanks to the Affordable Care Act (ACA).
Verma has been nominated to head the federal agency that insures 100 million people through Medicaid, Medicare, the Children’s Health Insurance Program and the health insurance marketplaces established by the ACA. For her to suggest that health plans should be able to discriminate by excluding coverage for a basic, essential women’s health service is alarming.
In the chaotic environment created by congressional Republicans — who are rushing to repeal the ACA without offering any clear, coherent plan to replace it — Verma’s comment is an ominous signal about what lies ahead if ACA opponents prevail.
Making coverage for maternity care optional could mean a return to the days when nearly nine in ten individual health plans sold in the individual market (88 percent) failed to cover maternity care. That meant even women and families with insurance faced exorbitant medical bills because their plans failed to cover maternity and newborn care, which are essential to the health and wellbeing of women and children. Moreover, prior to the ACA, even plans that covered maternity care offered that coverage at rates that were far from affordable: Many plans on the individual market required separate maternity deductibles that were sometimes as high as $10,000 per year, insurance riders exceeding $12,000 per year, and/or waiting periods of one to two years before maternity coverage kicked in. Needless to say, these plans were so expensive that many women who needed maternity coverage could not afford it.
Equally concerning is that Verma’s answer signals hostility to the ACA’s essential health benefits (EHB) provision – a primary reason the ACA has been the greatest advance for women’s health in a generation and a significant contributor to establishing a national standard of coverage. This provision ensures access to a defined set of benefits that includes coverage for maternity care, and also for preventive services, prescription drugs, mental health services and more. It was a landmark and meaningful advance for all consumers and for women in particular.
The ACA — and its EHB provision — corrected longstanding, persistent and discriminatory gaps in health coverage. We must not go back to the future on this. What Verma proposed, making maternity and newborn coverage optional once again, would be a major, costly setback for women, for children and for our nation’s health.