Of the health bills on Governor Brown’s desk, two of particular note would require health coverage to include maternity coverage.
Why is this important? Here’s our colleague Beth McGovern, from the California Commission on the Status of Women, giving one perspective as she answers a press question:
But there’s many other arguments as well.
While it seems difficult to argue that maternity care is vital to life, in the past few years, insurers in the individual market have relegated maternity coverage to a rarely-offered “optional” benefit. Six years ago, over 80% of plans included maternity, while now only 12% do. (This is one of the startling findings in the analysis on maternity benefits done by the California Health Benefits Review Program.) In some parts of the state, it is less than 1%.
Health Access staff checked the availability of health insurance that provides coverage for maternity in four markets in California: Redding, Bakersfield, Monterey, and Sacramento.
· In Monterey and Redding, literally 78 out of 79 products did not cover maternity.
· In Bakersfield and Sacramento, literally 80 out of 94 products did not cover maternity.
· In Monterey and Redding, only one product offered by one plan out of 79 products offered in the individual market for a woman age 32 covers maternity, a Blue Shield PPO with a $5,000 (five thousand dollar) deductible.
· In Bakersfield and Sacramento, out of 94 products offered in the individual market, the same Blue Shield PPO, one Healthnet PPO with $1,500 deductible and 11 Kaiser products covered maternity.
A family would have to look long and hard to find the one or two products that cover maternity. Those who purchase individual coverage with maternity face higher premiums because the costs of prenatal care are not spread across all purchasers of individual coverage.
Lack of access to pregnancy related services can have extremely detrimental effects on the health of mothers and children. As a result, the state of California allows pregnant women to be covered under Medi-Cal, and programs like Access for Infants and Mothers (AIM). When insurers fail to recognize maternity care as an essential health benefit, California taxpayers are then left picking up the tab. In 2006, 41.3%, or 232,241 births to resident Californians were paid by the Medi-Cal program. This number has inevitably grown as fewer and fewer insurers offer this benefit.
The Affordable Care Act signed into law by President Obama in March 2010 will define a set of minimum essential benefits that must be covered by all insurance plans by 2014, and maternity care will be included. But it is crucial for California to adopt this standard for maternity coverage in 2012 rather than waiting until 2014—not just to provide the benefit to California women, to our health providers, and to taxpayers as early as possible, but also to provide for an appropriate and smooth transition in 2014.
We need to give the health insurance market time to adjust to including this as a standard benefit for the entire market. In 2014, other changes in the insurance market rules will affect pricing of premiums, particularly in the individual and small employer markets. Finally, California has seen a startling decline in plans with maternity coverage over the past five years, and it is crucial that we halt that decline now, so the shock to the market is less severe than it would otherwise be, and less disruptive to consumers. We join with some insurers and health plans in supporting this measure as an appropriate “glide path” to full implementation of the federal law.
The two bills passed by the California Legislature, AB210 (Hernandez) and SB222 (Evans/Alquist) would implement a maternity care mandate in advance of 2014. Every child born in California deserves a safe and healthy start to life and it is important that Governor Brown sign these two important bills.