The Nation

Reformers Say Maternity Benefits Make Dollar Sense

Sunday, August 30, 2009

Health-reform advocates in Congress argue that it's cost-effective to end insurance bias against pregnant women and to make all types of insurance guarantee maternity coverage. Second of two articles.



Planned Parenthood volunteers

(WOMENSENEWS)--U.S. Rep. Rosa DeLaurio, the Democratic lawmaker from Connecticut, says gender discrimination is rampant in the individual insurance market and the treatment of pregnant women is the leading example.

In most states individual-market insurers are allowed to deny coverage to pregnant applicants. Even in states where companies must issue a policy, they are allowed to consider pregnancy a pre-existing condition and impose a waiting period for maternity services, which denies vital pre-natal care.

"I wouldn't qualify for an individual policy because I am an ovarian cancer survivor," DeLaurio said in an interview. "Women who have had a previous Caesarean section also may be excluded. Nine states allow individual insurance companies to deny coverage to survivors of domestic violence."

In most states, women pay more than men for identical coverage in individual market insurance plans, even for plans that don't cover maternity care.

Only 12 percent of the 3,500 individual insurance plans sold across the country cover comprehensive maternity services.

Health-reform advocates such as DeLaurio are using economic arguments to persuade resistant lawmakers in Congress that all plans--individual, employer-provided or governmental--should guarantee maternal coverage.

The American College of Obstetricians and Gynecologists, a professional organization of 53,000 physicians and other clinicians, has stressed in its presentations before congressional committees that for every $1 spent on prenatal care, $3.33 is saved for postnatal care and $4.63 in long-term health care costs.

Single-Payer Preferred

"We would prefer to have a single-payer system, but if that is impossible, we believe that insurance ratings and underwriting based on gender be prohibited in all insurance plans," said Cindy Pearson, executive director of the Washington-based National Women's Health Network, an advocacy group of 8,000 individuals and organizations founded in 1975. "With rising unemployment, more women must rely on the individual insurance market, which takes a severe toll on their ability to survive."

Judy Feder, professor of public policy at Georgetown University in Washington, predicts that the final-insurance reform bill –expected to emerge around late September– will require maternal coverage in all insurance plans.

"Over the past 30 years, women and their allies have done a wonderful job of presenting the evidence that gender discrimination in insurance hurts individuals and families as well as the nation," said Feder, who served as staff director of the congressional Pepper Commission, one of the first groups to address health care reform in the 1990s. "Republicans as well as Democrats, and men as well as women in Congress, realize that ending gender discrimination in health insurance is long overdue."

Historically, health insurance plans didn't cover pregnancy because prenatal care was viewed as a predictable expense.

That's because health insurance--which began gaining ground in the United States during World War II--was intended to protect people from unexpected events such as heart attacks, strokes and cancer. Pregnancy was excluded on the assumption that couples knew before they had intercourse that a pregnancy could result, so they should have set aside funds for prenatal care.

This started to change in 1978 when Congress passed the Pregnancy Discrimination Act, which guarantees maternity coverage for women employed by firms with 15 or more employees or who are members of unions.

"Unfortunately, many women still fall through the cracks," Dr. Gerald F. Joseph Jr., president of the Washington-based American College of Obstetricians and Gynecologists, said in a telephone interview. "One out of six women in the U.S. works part-time--often because of family-care responsibilities--and doesn't qualify for an employer-sponsored plan. Women who work for very small firms or in low-wage jobs that don't offer benefits also aren't covered and must go without coverage or obtain an individual policy, which is more expensive and often does not cover maternity care."

Sharon Johnson is a New York freelance writer.

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For more information:

ACOG's Coverage for All Women page
http://www.acog.org/departments/dept-web/dfm?recno=44

National Women's Health Network
http://www.nwhn.org/

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