February 7 2017
According to Obamacare's cheerleaders, the law made it so that pregnancy is no longer a "pre-existing condition," meaning pregnant women can sign up for health insurance plans on the exchanges during open enrollment. The same cheerleaders bemoan Republicans' plans to repeal and replace Obamacare, because they fear pregnant women will have fewer options for health insurance and limited access to care.
While Obamacare's requirement that insurance companies sell plans to pregnant women on the exchanges may sound like a commonsense and pro-woman protection, it is neither. In order to best serve women patients, our health policy should reflect the reality of what pregnancy truly is and what insurance truly should be.
Some critics of Obamacare argue that it doesn't make sense to allow someone to buy health insurance after she is already pregnant; they say this is like buying homeowner's insurance after your house is on fire. I don't like the analogy. Pregnancy — as opposed to a house fire — is cause for celebration.
But of course, pregnancy requires great personal care and increased healthcare services in the form of doctors' visits, tests and ultimately medical assistance with the delivery. In this sense, the house-fire analogy holds up. If health insurance is meant to protect us from unforeseen costs (as other types of insurance do), then the costs of an already-happening pregnancy are not unforeseen. They are expected.
To require insurance companies to sell policies to pregnant women goes against the concept of insurance. It encourages opportunism, too. I could go without insurance until I got pregnant, and then I could enroll (presuming open enrollment came around sometimes during my nine months).
It would be better to encourage more women to purchase health insurance before becoming pregnant. Sadly, Obamacare has increased premiums dramatically on many healthy women of child-bearing age, which may discourage these women from obtaining insurance until they are sure they need it. This is counterproductive to the goal of protecting women from the costs of uninsured pregnancies.
Rolling back Obamacare's regulations, therefore, would help bring down premium prices and make it possible for more people to afford insurance. Therefore fewer people would face a pregnancy — or any other condition that requires treatment — while uninsured.
Even so, there may always be cases where women become pregnant without insurance. There are options for them too, and these options would remain accessible even absent Obamacare.
Let's address the most vulnerable women first — low-income women. Nearly half of all births in the U.S. are to mothers on Medicaid, and this was the case before Obamacare expanded the government program for the poor. Today, income thresholds vary (from 133 percent to 185 percent of the federal poverty line), but low-income pregnant women in all 50 states can enroll in Medicaid at any point in their pregnancy, and they will be covered until 60 days postpartum.
This isn't a result of Obamacare; it's due to policy changes that date back to the late 1980s, and no one is advocating taking healthcare away from poor pregnant women or their babies. Repealing Obamacare would not take away Medicaid coverage for the poorest pregnant women. To suggest otherwise is to fear-monger.
What about women who are ineligible for Medicaid?
Before Obamacare, pregnant women could get plans through their state's high-risk pool if they had one. It didn't matter what time of the year it was (women could enroll anytime, not just during "open enrollment.")
Premiums for these plans may have been high, but they were still better than paying out-of-pocket for prenatal care, labor and delivery, especially for pregnancies or births with complications. This would be a better way to offer insurance to already-pregnant women than the Obamacare approach.
Women always have the option of going through their pregnancy without insurance, in which case there are discount programs and payment plans that make care more affordable. Importantly, pregnant women can take advantage of a wide range of charitable resources and supports, from homeless shelters dedicated to their care to free clinics and pregnancy resource centers.
No one wants to see pregnant women struggle to afford or access care. It's a worthwhile debate to consider what role the government should play in providing a safety net for those who can't afford insurance or who just mistakenly went without insurance and had an unforeseen medical event.
But for women who can afford to buy insurance, it is better to encourage them to do so before becoming pregnant rather than inviting them to wait until after becoming pregnant to obtain insurance, thus causing problems that ripple throughout the entire insurance system.
Repealing Obamacare would make insurance more affordable for these women and would ultimately improve the options available to them — that's a step in the right direction for pregnant women, and the rest of us.