WASHINGTON ― One of the most heralded aspects of the Affordable Care Act was the fact that it no longer made being a woman a pre-existing condition.
Before 2010, women often had to pay more than men for the same coverage. Only 12 percent of individual market plans covered maternity care. And it was completely legal for insurance companies to refuse coverage to women who were pregnant or might become pregnant in the future.
Obamacare changed that. The law created a list of 10 essential health benefits that all plans on the marketplace must cover. Pregnancy, maternity and newborn care are on that list.
President Donald Trump wants to get rid of that mandatory benefit. On Tuesday, White House spokesman Sean Spicer pointed to maternity care as a reason that insurance costs were so high and said it was unfairly burdening men and older people who don’t need such services.
He argued that costs would go down if people had more choices for a la carte services.
“A 54-year-old doesn’t need certain things. They don’t need maternity care,” Spicer told reporters in his press briefing. “They don’t need certain medical services that are being provided to them by this government product that is being forced on them right now.”
“You’ve got young people being told to buy packages that have end-of-life care that they don’t necessarily need, you have people in their older phases of life having to buy stuff for maternity that may not be a service that they need at their stage of life,” he added.
“When a mom can go and get prenatal care and a baby is born healthy, we all benefit by that.”
The GOP’s current bill to replace Obamacare would not change the requirement for insurers to offer maternity care. But the Trump administration has made clear that the American Health Care Act is only the first step in what it sees as an approach with “three prongs” that would include the types of changes to coverage that Spicer outlined.
“Sean Spicer’s comments illustrate how dangerous it is to allow people to propose health policy for this country when they don’t understand how insurance works and apparently don’t believe in ending discrimination against women,” said Gretchen Borchelt, vice president for reproductive rights and health at the National Women’s Law Center.
The way insurance works is that everyone pays into a system so that those who need the money get it in their time of need. You may never have cancer, but your insurance payments are helping to fund others who will. Women don’t have prostates, but their insurance premiums go to men’s prostate cancer screenings and treatments.
“We shouldn’t allow insurance companies to say men’s health care is basic health care, but women’s health care is not,” Sen. Debbie Stabenow (D-Mich.) said.
Removing the maternity care requirement would return the health care system to a time when women faced a high price simply because of their gender. Insurance companies would have more power on what to cover and whom they could deny.
With only a fraction of plans on the marketplace offering maternity care, women often had to bear the extra cost burden since insurance companies didn’t have to. They might have had to pay thousands of dollars for a maternity coverage rider and typically had higher deductibles.
Andy Slavitt, who was President Barack Obama’s acting administrator of the Centers for Medicare and Medicaid Services, told ABC News that if maternity care and other services were made optional, they’d likely become scarce.
“Once something is not required, it becomes difficult for one company to offer it,” he said. “It can be a tough business decision. The fear is that you may attract only sicker folks. It can be a race to the bottom, in terms of what’s offered.”
And even though nearly half of the pregnancies in the United States are unplanned, women would have to purchase this maternity coverage months in advance of being pregnant ― otherwise it could be considered a pre-existing condition for which insurance companies could deny coverage.
“Picking and choosing among health services undermines the fundamental principles of insurance, and it leaves individuals without the care they need when they need it,” Borchelt added. “We saw this before the Affordable Care Act, when only 12 percent of individual plans covered maternity care, yet charged women more than men for coverage that didn’t even meet their needs. This left women without the care they needed, and left women and families saddled with huge bills. The health care law ended this discriminatory practice, making sure plans cover maternity alongside other essential health benefits.”
Many experts also say that maternity care has not been a significant factor in higher costs. A 2016 study by Blue Cross Blue Shield Association, for example, said new enrollees in the previous two years tended to be sicker and require more expensive medical care.
“Relative to other market changes, there is no indication that required coverage for women’s health benefits was a primary driver of premium increases,” Caroline Pearson of the consulting firm Avalere Health told The Associated Press.
But even as the Affordable Care Act was being debated, many Republicans were baffled as to why women shouldn’t have sole responsibility for paying for plans that cover maternity care. One of the most memorable moments from the congressional debate was during a hearing in 2009, when Stabenow reminded a male GOP senator why services such as maternal care benefit everyone.
“I don’t need maternity care, and so requiring that to be in my insurance policy is something that I don’t need and will make the policy more expensive,” then-Sen. Jon Kyl (R-Ariz.) argued during a hearing in September 2009.
“I think your mom probably did,” Stabenow shot back.
“The point of it was, we are all connected,” Stabenow explained to The Huffington Post this week. “There are essential basic services in health care that should be available for men and women, as well as children. ... When a mom can go and get prenatal care and a baby is born healthy, we all benefit by that.”
“Providing maternity care as part of basic health care actually saves tremendously in health care costs ― rather than a complicated pregnancy [and] health problems for babies,” she added. “It not only makes sense from a quality of life standpoint and the standpoint of women being able to be treated fairly in the health insurance market ... but it also saves dollars overall in the health care system.”
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