Setting the Record Straight on Guaranteed Maternity Coverage

by | Nov 1, 2013 | Paid Leave

This week, there’s been a lot of misinformation from politicians, amplified by the news media, about some key reforms in the Affordable Care Act (ACA).  We have been especially appalled by attempts to call into question the value of including maternity coverage as an essential health benefit that must be covered by all plans in the marketplaces.  

At a hearing on Wednesday, Rep. Renee Ellmers (R-N.C.) inquired as to how a single male could ever “need” maternity coverage and implied that required inclusion of maternity coverage is unnecessary and unduly burdensome.  Her comment should be recognized for what it is: an endorsement of the broken health care system that preceded the ACA – an inadequate system that consistently failed and blatantly discriminated against women.

The ACA was enacted to improve access to quality, affordable health insurance and to prohibit insurers from discriminating against people because of their gender or health status. Indeed, the law not only guarantees access to coverage; it guarantees access to comprehensive coverage that is high-quality and covers needed health services. To ensure that Americans are able to find an affordable plan that meets their basic health care needs, the ACA requires all plans sold in the marketplace to cover ten categories of essential health care services, including ambulatory care, maternity and newborn care, prescriptions, preventive and wellness services, rehabilitation services and more. These essential health benefits weren’t selected because we need them all, at all times. They were selected because they are necessary components of health and well-being and because we value the social benefits that result from improved access to these services.  

Guaranteed access to health coverage that includes maternity and newborn care will benefit our society’s health tremendously.  Maternal and infant mortality is higher in the United States than in almost any other developed country in the world.  The impact of significantly improving access to comprehensive health insurance that includes preventive care and coverage for maternal and newborn health care will have far reaching benefits for the country.

Conversely, allowing insurers to exclude maternity benefits from individual health plans threatens the health and economic stability of women and families.  Prior to enactment of the ACA, only 12 percent of plans sold on the individual market offered any coverage for maternity services.  Women and families buying coverage on the individual market were forced to pay for plans that did not include maternity-care benefits because they had no other options. The typical out-of-pocket cost of pregnancy and delivery, without any complications, is upwards of $10,000. Total out-of-pocket costs can run as high as $25,000. Prior to the ACA, when it came to pregnancy, many women who bought individual health plans found themselves no better off than their uninsured counterparts.

Guaranteeing access to coverage for maternity and newborn care is one of the most important steps we can take to improve the health of moms and babies and protect the economic security of families. Requiring all marketplace plans to include maternity coverage not only guarantees that women are treated equally in the insurance market, it also protects women and families from exorbitant pregnancy-related medical bills. We should all be embracing these benefits, not disparaging them.