Awaiting Appropriations…

While we wait for the Appropriations Committees in both the Senate and Assembly to decide the fate of key health care bills (like AB52 on rate regulation, but several others), let’s highlight one that we have focused on for a longtime: the issue of requiring maternity coverage as a basic benefit.

Timm Herdt at the Ventura County Star has an excellent write-up of the maternity bill, and why it’s important, especially in this particular time:

Seven years ago, a woman could pretty much count on the assumption that if she had insurance, it would cover maternity care. Federal law required all employer-sponsored group health plans provide that benefit, and 82 percent of policies purchased in the individual insurance marketplace included the coverage.

Today, the federal mandate for group health plans still applies, but the ratio in the individual insurance market has been turned upside-down: Only 13 percent of policies sold in California cover prenatal care and labor and delivery costs for new mothers.

Among private insurers, say health care advocates, the trend reflects a race to provide the lowest-cost policies that provide the least amount of coverage.

“If you don’t have a good floor, you allow the market to force a race to the bottom,” said Anthony Wright, executive director of Health Access California. “As costs have gone up, insurers have looked at ways to provide a cheaper product.”

The exclusion comes as a surprise to many expectant mothers, says Dr. Philip Diamond, a San Diego physician who chairs the legislative committee for the state chapter of the American Congress of Obstetricians and Gynecologists.

“Women often don’t know,” he said. “They get pregnant, then make an appointment to see me. When they learn they don’t have coverage, they quickly have to find other options and it delays their early prenatal care.”

Those other options typically involve enrolling in publicly funded insurance programs. To privately pay for maternity service would cost $14,000, the average cost for an uncomplicated delivery.

All that could change beginning next year, depending on the outcome of a bill that would require all individual policies to include maternity benefits. The measure, SB 155 by Sen. Noreen Evans, D-Santa Rosa, is the only one of a handful of proposed coverage mandates introduced in the Legislature this year that lawmakers have allowed to move forward.

It will face its toughest hurdle today, when the Assembly Appropriations Committee decides whether to allow it to advance to a vote of the full Assembly.

We hope SB155(Evans) advances today and passes into law.

Beyond providing a real benefit to Californians, it would also allow a smoother transition, a “glide path” to 2014, when maternity coverage will be part of an essential benefits package. Starting in 2012 with this benefit will give the market time to adjust, and prevent the gaming of the market by the insurers. We’ll report what happens…

Health Access California promotes quality, affordable health care for all Californians.

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