Speaking of Women's Rights...: Of Birthdays and Health Care Reform

Wednesday, July 8, 2009

Of Birthdays and Health Care Reform

Monday was my son’s birthday. While birthdays usually bring to mind thoughts of cake, ice cream, and presents, this year, with health care reform in the air, I’ve been thinking about the medical and economic side of childbirth – and how different the experience might have been if I hadn’t had comprehensive health care coverage and access to a full-range of services.

First, what if I hadn’t had access to job-based health insurance? If I didn’t qualify for Medicaid (a whole other can of worms with regard to reproductive health care), I might have sought health insurance on the individual market.

If I were already pregnant, an insurance company might either exclude maternity care (including prenatal care) by deeming the pregnancy as a “pre-existing condition,” or reject me altogether. This could well be perfectly legal; while statutes prohibit gender discrimination in employment benefits, most states do not expressly prohibit the use of gender, health status, or age in individual market insurance.

As with other types of health care, a huge issue for private maternity care coverage is the cost. It would be OK in many states to charge me more for a basic policy simply because of my gender on the assumption – sometimes, but not always borne out – that any individual woman would incur more health care expenses. Further, many individual market policies don’t even include maternity care as part of the standard policy, so women have to pay more for supplemental maternity insurance on top of the already expensive basic policies.

After I returned home with my new baby, I could then look forward to the hospital bill. Without maternity care benefits, the average hospital charge alone for having a child ranges from $7,500 for a vaginal delivery without complications to $17,000 for a Caesarean delivery with complications. Depending on the policy, in some cases I might even end up paying more with insurance! (See page 12 of the National Women’s Law Center’s report.) It is no wonder that having a child is a leading cause of poverty spells for families.

And for the next kid? I might have been denied health insurance coverage altogether because my first child was delivered via Caesarean section. And also because I had a previous C-section, I might not even be allowed to attempt a VBAC (vaginal birth after Caesarean) – even though avoiding surgery is often better for the health of the mother and the baby, and cheaper, to boot. (The U.S. C-section rate, by the way, rose to a record 31.8 percent in 2007 – far higher than the World Health Organization-recommended 15% for developed countries, and an increase of over 50% in the past 11 years.)

Suffice it to say, I’m feeling pretty lucky things turned out as they did for my family. But I’m feeling equally passionate that comprehensive health care reform must ensure that all pregnant women and newborns have access to the quality medical care I and my son had. A birthday should be a cause for celebration, after all.