A mind-blowing article appeared in the NY Times recently about the high cost of having a baby in the US. As part of an interactive feature, the author asked the reader how much a pregnancy cost in the US. As an average woman in her twenties, who has never been pregnant before, I settled with an estimate of a few thousand dollars. The real answer shocked me: an average pregnancy in the US costs $37,341.
Surely, this was mistake! Was I reading the answer correctly? Did I mistake this for another country? No, no, no.
According to a recent study by Childbirth Connection, women with commercial insurance generally pay 12% in out-of-pocket costs (between $2,244 and $2,669) for childbirth, while women with Medicaid get nearly all costs of birth covered. Insurance providers and the government take up the rest of the bill, meaning taxpayers and health insurance consumers end up paying, too. Given that today health care is supposed to be more affordable, more patient-focused, and more evidence-based, I could not understand how a procedure that a majority of women face during their lifetime could literally break women’s hard-earned banks. I decided to investigate how this outrage could exist and whether the Affordable Care Act (ACA) would help lower maternal health costs for women.
The main reasons that pregnancies are so expensive in the US are the increased use of unnecessary medical interventions for low-risk pregnancies, such as C-sections and inductions, as well as the high cost of medical malpractice insurance for OB/GYNs. Moreover, cost-saving and effective alternatives to hospitalized births (such as the use of midwives or birth centers) are grossly underfunded and in some cases highly restricted or even illegal because state laws, with doctor support, make it difficult for them to become licensed even when they are just as safe (and arguably even safer) for women with low-risk births.
Luckily, the ACA works to correct some of these problems. The ACA provides a number of benefits to pregnant women that will hopefully lower the costs of pregnancies in the US.
Some of the benefits are specifically applicable to pregnant women. For example, in terms of access to maternal services, the ACA mandates that plans allow direct access to an OB/GYN without prior authorization from a health plan or doctor referral. The ACA also provides better support for nurse-midwives and birth centers, which are more affordable than having a baby in a hospital with an OB/GYN.
In a ground-breaking move, the ACA also requires new insurance plans to cover women’s preventive services without cost-sharing (i.e. deductibles, co-pay, etc.). The services related to maternal health include breastfeeding support and supplies, gestational diabetes screening, and well-woman visits for prenatal care. Moreover, it also requires new insurance plans to provide an “essential benefits” package that includes maternal and newborn health services.
In terms of better assistance and education, the ACA includes grants for home-visiting programs which would provide information and services to at-risk communities about pregnancy. The ACA also provides better treatment for pregnant women needing comprehensive tobacco cessation services and for women suffering from post-partum depression.
The ACA also includes provisions that apply to all women, but will help pregnant women in particular. One of the most important changes the ACA makes is that it incentivizes states to expand Medicaid - so in states that choose to, Medicaid covers women at or below 133% of the poverty line. Importantly, it also prohibits certain insurance plans from denying coverage based on pre-existing conditions (such as C-sections), from rescinding coverage when a woman becomes pregnant or incurs high medical costs, and from imposing lifetime and annual limits. There are also provisions that cap out-of-pocket costs.
To make finding a plan easier, the ACA requires states to implement an online marketplace for people to make apples-to-apples comparisons on health insurance plans.
Finally, the ACA also fights gender discrimination by eliminating gender rating in certain insurance plans. Gender rating is where insurance companies charge women more than men just for being a woman.
Much more can be done to ensure that pregnant women are guaranteed their right to affordable health insurance – including, for example, ensuring insurance coverage for women who choose to terminate their pregnancies; currently, the ACA places restrictions on insurance coverage for abortion. However, at least the ACA is a step in the right direction!
Megan Veith is currently a legal intern at Legal Voice. She just finished her second year at Georgetown University Law Center, after graduating with her Bachelor’s Degree at the University of Washington. Megan is a strong advocate for women’s rights and is thrilled at the opportunity to fight for equality for all people at Legal Voice.
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