In June of 2010, even though I’d had a private Anthem policy for years (paying full and timely premiums), even though my policy literature stated that it covered reproductive health (I’d checked before getting pregnant), and even though my coverage cost over $300 a month (for one 32-year-old in 2010, certainly not an emergencies-only rate), the company determined that my pregnancy was a pre-existing condition.
According to Anthem, women’s reproductive health didn’t include childbirth or prenatal care.
I didn’t know it, but I was one of the 62% of American individual-market enrollees who didn’t have maternity coverage. Nor could I purchase additional coverage; pre-existing conditions didn’t qualify.
I was sickened—my first feeling of maternal panic. I investigated my options. Anthem was out, altogether. I was in grad school at the time, and my student health insurance, which I’d waived because I thought I had such good private insurance, would take me back, but wouldn’t cover the pregnancy until a six-month waiting period had passed—which meant no prenatal care until two-thirds of the pregnancy was over. My only option, they told me, was Medicaid, which would help me immediately.
My pregnancy just missed the protection of the Essential Health Benefits provision of Obamacare, which prohibited insurers like Anthem from offering plans with inadequate coverage—including reproductive coverage that didn’t cover reproduction.
Unfortunately, the Senate’s latest healthcare bill gives states permission to waive EHB. And thus gives insurers permission to deny pregnant women prenatal coverage, by offering inadequate policies. Sure, the Senate claims that I wouldn’t be denied coverage for my pre-existing condition. But if the policy I can afford isn’t required to cover that pre-existing condition? That’s tantamount to denial.
Thank God that my grad student stipend qualified me for Medicaid. Despite a healthy weight and a strict low-carb eating plan, I ended up with the gestational diabetes that runs in my family. If I’d forgone prenatal care, as my student health insurance and Anthem pressed me to, my child and I would have been at serious risk.
Unfortunately, the Senate bill squeezes pregnant women and other folks with pre-existing conditions on both sides: by gutting EHB, it guts the insurance plans they can buy privately or through work, while it also cuts federal Medicaid funding for folks who qualified under the Obamacare expansion.
The incredible mercy of public health insurance—Medicaid was a program I’d never used before, and one that came through just as my family desperately needed it—saved me when private enterprise put my body, and my child’s body, in harm’s way.
Anthem took no responsibility for its misleading literature. This wasn’t some obscure, shady, hole-in-the-wall company that happened to scam me into insufficient coverage. This was the second-largest insurance provider in the nation, with a nine-percent market share. This was standard industry practice: before Obamacare, 88% of individual-market insurance plans lacked maternity coverage.
Misrepresentation, indifference, insufficiency: these are the kind of shenanigans that emerge when for-profit entities are left to make moral decisions. Private enterprise is amoral. It should not make life-and-death choices without accountability. The EHB provision provides such accountability. Please urge your senator to ensure that it remains intact.