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Making Maternity Coverage Optional Would Raise Women’s Health Care Costs

February 17, 2017 at 2:45 PM

“Women should be able to make the decisions that work best for them,” including whether their health coverage should include maternity benefits, says Seema Verma, President Trump’s nominee to run the Centers for Medicare and Medicaid Services (CMS). But making it optional for insurers to cover maternity care, as they now must under the Affordable Care Act (ACA), would endanger women’s access to maternity services and raise costs for women and their families when they do have babies.

Verma’s comments are significant because, if confirmed as CMS’ administrator, she would oversee marketplace coverage under the ACA as well as the federal standards for individual and small-group market plans and insurers.

Given a choice, men and women who don’t expect to become pregnant would enroll in less-expensive plans that don’t include maternity coverage. Knowing that only women who expected to become pregnant would buy the coverage, insurers may not offer maternity benefits at all — or they’d likely charge high additional costs to women who wanted coverage for maternity care in their plans.

In 2011, 62 percent of individual market enrollees didn’t have coverage for maternity services, the Department of Health and Human Services found. Women often had to buy “extra” insurance to get maternity coverage, or find another way to cover the costs of having a baby. The Affordable Care Act (ACA) strengthened coverage for maternity care and banned health insurers from charging higher premiums due to a person’s gender. Before 2014, women had to pay more than men for coverage in the individual market, even for coverage that didn’t include maternity care. For example, a plan in Arkansas charged a 25-year-old woman 81 percent more than a 24-year-old man enrolled in the same plan.

The ACA included maternity care as one of the ten essential health benefits, which means that all health insurers in the individual and small-group markets have to cover it. Giving everyone access to a standard set of benefits spreads the costs of expensive services such as maternity care or cancer treatment among a larger group of people — whether those people are having a baby or getting treatment for a high-cost illness such as cancer.

The ACA has made maternity care accessible and affordable. We should keep it that way.

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