For my patients in inland Southern California, being pregnant isn’t easy. I am one of few obstetricians in this region, where patients travel far to get to appointments and often don’t have the money for even basic medications.
The 2010 Affordable Care Act (ACA) made a huge difference for my soon-to-be moms. Every healthy baby born is a testament to the success of the historic law, which required coverage for prenatal care and expanded Medicaid to more low-income women. The latest plan to repeal and replace the ACA, announced today by House Republicans, would give states the ability to opt out of covering prenatal care and other “essential health benefits” via a waiver from the federal government, which would allow them to do so if they felt opting out would help states reduce premium costs and increase coverage.
In other words: Republicans are choosing to cut costs by taking away health insurance from moms and babies.
Making pregnancy health insurance “optional” is gender-based health care discrimination. Section 1557 of the ACA is the first and only federal regulation that that explicitly outlaws gender discrimination in health care, and without such protections health insurance plans will use pregnancy as a reason to increase premiums and deny insurance to women. Before the ACA was passed, 60 percent of private insurance plans that a woman could buy excluded pregnancy coverage. Plans with maternity benefits had monthly premiums 20 to 75 percent higher than plans that didn’t. Letting health plans avoid covering pregnancy unfairly leaves women with fewer and more expensive health insurance options.
This discrimination has serious health consequences. Taking away health insurance during pregnancy threatens the health of moms and babies. The U.S. is the only industrialized country where birth complications and pregnancy-related deaths are on the rise. We also have some of the highest rates of infant and newborn deaths in the developed world, with striking inequities for babies born into minority and low-income families. Babies of mothers who do not receive any prenatal care are five times more likely to die after delivery than those of mothers who received maternity care. Republicans need to know that restricting access to prenatal care is a dangerous proposition.
Investing in prenatal care also produces large economic returns. We know that moms who start prenatal care early and attend more of their appointments are less likely to have a premature or low birth weight baby. One in ten babies in the U.S. is born prematurely, and prematurity is the top cause of infant hospitalization and death. Intensive care for these tiny babies cost our health care system $20 billion in 2014. In the first year of life, medical care for a premature baby will be more than ten times as expensive as care for a healthy infant born on time. This doesn’t even capture the family costs of missed work days, childcare for siblings and transportation to and from hospitals and clinics. Republicans, claiming that an urgent repeal of the ACA will control health care costs, don’t understand that the cost of one prenatal visit is a fraction of the cost of one day in a newborn incubator.
Guaranteed maternity care coverage is just one ACA policy that has improved health for U.S. women, many of which came via its “essential health benefits” mandate. Allowing insurers to exclude these basic services will erode the foundation of women’s health in the U.S.
Sacrificing care for pregnant women to satisfy Republican rhetoric is wrong. For moms and babies, health insurance is about more than politics–it’s a matter of life and death.