WASHINGTON – Pregnancy should be classified as a life event for the purpose of gaining health insurance in the Affordable Care Act’s federal marketplace, according to a proposal supported by the American Congress of Obstetricians and Gynecologists and other advocacy organizations.
Under most insurance – both public and private – the birth of a child is considered a life event, allowing a parent to enroll in or change coverage. Pregnancy, in general, is not.
Young Invincibles, an advocacy group representing the interests of 18- to 34-year-olds, is calling on the U.S. Department of Health & Human Services to require a special enrollment period for pregnancy for federal marketplace plans and encourage state marketplaces to do the same. ACOG and the March of Dimes support the effort.
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A new message is needed to encourage the change, according to Dr. Jack Ludmir, chair of obstetrics and gynecology at Pennsylvania Hospital in Philadelphia, who spoke at a briefing held Feb. 18 by Young Invincibles.
“We’re learning more and more about the things that happen in pregnancy and the stresses and factors that could be responsible later in life for cardiovascular disease and malignancies and metabolic syndrome,” Dr. Ludmir said. “We need more people articulating ... this to Congress.
Strong prenatal care is “an incredible opportunity to mold how not only [the mother], but how that future baby, child, adult is going to do and I think it’s an important message that we haven’t articulated and we should because I think it is going to make a difference,” Dr. Ludmir said.
A report released by Young Invincibles points out that pregnancy-related complications are often more expensive than prenatal care itself, noting that complications from preeclampsia can cost uninsured patients more than $18,000.
Before implementation of the ACA, most individual insurance plans did not cover maternity care, according to Christiana Postolowski, health policy manager at Young Invincibles. Certain plans, including certain grandfathered plans, as well as those canceled health plans that have been allowed to offer coverage through 2016, still might not do so now.
“In these first few years of the ACA, we are still seeing women who find themselves pregnant and find out that their plan, lo and behold, doesn’t cover the care they need,” she said.
HHS Secretary Sylvia Burwell was asked about a special enrollment period for pregnancy at an ACA briefing Feb. 18. She said that the government generally follows insurance industry practices when determining which life events would qualify for a special enrollment period, but added that “this is an issue that we are happy to ... have raised.”