Health care reform didn’t fix our class problems

Here’s a funny story: Obamacare offers open enrollment periods for only part of the year, but it offers an exception for ‘qualifying events,’ which allow people to sign up anytime when they’re experiencing medical crises. It’s all part of the magic of health care reform in the US, where the theory is that health insurance will magically fix all your problems. To be fair, if you’re facing, say, $40,000 in medical bills, having insurance that will cover part of that will definitely help — but that’s if you can afford the insurance and the copays.

But I’m not here today with my usual rant about how forcing people to buy health insurance doesn’t actually ensure access to health care. I’m also not here to discuss subset b of this rant, in which we talk about the fact that health insurance can be prohibitively expensive for people who are not necessarily offered support on the health care exchanges (in states that have them) between premiums, copays, deductibles, and the like.

I’m here to talk about pregnancy.

Pregnancy isn’t necessarily a medical emergency, but it should definitely be considered a qualifying event. Because pregnancy in the US is extremely expensive, between prenatal care, delivery costs, and followup care. If any complications develop, the costs can skyrocket — something pregnant people are painfully aware of when they decide to pursue pregnancy, decide to continue with an unplanned pregnancy, or go through the emotionally and physically grueling experience of assisted fertility treatments. Pregnancy is a big commitment, and you haven’t even gotten to the raising a human being part at the other side.

That sounds rather a lot like a qualifying event to me — a potentially costly medical issue that should be mitigated by insurance. That’s the whole point of the Affordable Care Act, right? To make access to health care easy, and to facilitate access to care when you need it. Exceptions to the open enrollment period are critical for people who need expensive medical care quickly. Of course, just because their insurers are required to cover them doesn’t mean they won’t make them pay a heavy price for their preexisting conditions.

But the ACA didn’t consider pregnancy to be a ‘qualifying event.’ And the fact that this was even a thing — that pregnant women couldn’t get coverage when they needed it — highlights both why the patchwork, piecemeal implementation of health care reform in the United States is beyond ridiculous, and also the underlying sexism in health care administration. Because the difference in treatment options for men and women when it comes to ‘qualifying events’ and unexpected medical issues is pretty sharp.

There’s already a historic precedent with ridiculous differentials in care coverage, like the tendency to cover boner pills but not birth control, and to provide coverage for prostate exams but not pelvic exams and pap smears. For insurance customers, the message couldn’t be clearer: Cis men were more important than cis women. For trans insurance customers, the problem was even more acute — many trans men who chose not to get bottom surgery struggled to get coverage for pelvics and paps, for example. Conversely, trans women who needed prostate exams and various urological care had to fight for it too, with insurance companies flat-out refusing to pay bills because their genders didn’t match with the adjustor’s perception of their bodies.

Refusing to cover pregnancy, though, is a particularly dire and misogynistic strike aimed primarily at cis women — though undoubtedly the ACA designers were also pleased that people of other genders who can get pregnant would also be caught in the crossfire. Because this was most definitely designed. This isn’t about an oversight or a whoopsie or any number of other things. People constructing the architecture of health insurance reform were well aware that a sizeable portion of the population can get pregnant at any given time, that a reasonable subset of that population is in fact pregnant right this very second, and that pregnancy can be one of the most expensive costs in a person’s life if that person is otherwise healthy. No really: The United States is basically the most expensive place¬†in the world¬†to get pregnant.

So this was very deliberately targeted at uninsured people with the capability of getting pregnant. Which is interesting, given the foetus fetish that is so abundant in US culture, including on the US left. Apparently foetuses are super important, but caring for the people who are carrying them is not, which, again, is weird, because parents who aren’t provided with access to good health care before delivery can run some serious risks — pregnancy outcomes are better when people are healthier, bluntly. But I seem to be forgetting that the US right doesn’t actually care about living children, only foetuses, my bad.

What was the goal, here? To remind people who can get pregnant that they’re not considered worthy of even the most cursory health care? To force people to get insurance during open enrollment in case they might get pregnant, even if the cost of said insurance is prohibitive and stressful? To encourage people to get abortions because they can’t actually pay for their pregnancies? No, seriously, what are you supposed to do if you get pregnant, evaluate the costs, and find them totally beyond your means? Cost is a very real issue for people making important decisions like whether they want to become parents and we shouldn’t pretend that it isn’t.

When you refuse to classify pregnancy as a health condition (albeit one that’s very normal and that ends in many cases with a perfectly healthy and happy outcome), you put pregnant people at serious risk. And you send a clear message about who is valued in society, and who is not.

Image: pregnant, Il-young Ko, Flickr