Maternity care: Still not covered under ACA

Pregnancy: Quite common for nearly half of bodies in the United States! Often a not only desired but actively sought out state, followed by delivery of an infant and parenting of a child! For many people, a pretty significant life event! For some, one of the most significant interactions with the health care system that will take place over the course of a lifetime! In other words, pregnancy is a big fucking deal, not just in the United States but around the world.

But perhaps a bigger deal here than in some other regions, because we have an absolutely shite maternal mortality rate despite supposedly having a highly advanced medical system, and the costs of pregnancy remain sky-high here. Think tens of thousands of dollars for delivery alone, before we’ve even got round to the costs of prenatal care, potential costs associated with post-partum health care problems, and, oh, any and all expenses associated with complicated or high-risk pregnancies and pre-term deliveries. Having kids: Super expensive before you even get into the raising them part, it turns out.

Giving birth in the United States is getting more dangerous and more expensive over time, which is deeply disturbing considering the resources the nation has available. And this was one thing the Affordable Care Act was supposed to address, by reforming health care to promote advances and developments in care, and to increase access to affordable health care services. Pregnancy, long excluded or poorly covered, was supposed to be one of the key areas of reform under ACA, along with issues like gynecological health — funny how many of the areas of poor insurance coverage have historically involved cis women and others with internal genitals.

Anyway, that funny coincidence aside, ACA was supposed to extend adequate health care coverage to people of childbearing age, ensuring that they could get the comprehensive prenatal care they needed, paired with excellent labour and delivery services, followed with strong postpartum followup, all of which are key components in delivering healthy babies and seeing families up for success. The US still hasn’t come round to the idea of providing more extensive postpartum support like, you know, paid time off and health care visitors and other community-based supports, but it’s making progress in fits and starts.

Except, peculiarly, for people under 26.

Here’s an interesting fact about ACA: One of the initiatives under the law extended the age at which dependent children could stay on their parents’ health insurance, with the goal of promoting increased enrollment in coverage. Health insurance is expensive no matter what Obamacare supporters say, especially for younger adults just entering the labour market, struggling with college debt, and trying to right themselves in a very expensive society. Insurance can be too much of a cost burden, and remaining on their family plans provides them with more options and access. Under ACA, people up to age 26 can leech off their parents — er, take advantage of their parents’ health insurance plans.

Here’s the problem: Insurers really hate covering maternity care and related costs, because they’re extremely expensive and insurers don’t like paying out money. They carefully investigated every possible loophole pre-ACA and took advantage of it, and the same holds true now, one reason Obamacare isn’t really working as intended. In the case of pregnancy, people under 26 are being excluded from maternity coverage for labour and delivery costs, because coverage for prenatal care is required under ACA, but not coverage for actual labour and delivery. Insurers covering people on group insurance plans, which are obligated to provide maternity coverage, are neatly sidestepping that requirement for dependent children.

It shouldn’t escape notice that people in their early 20s are often interested in starting families. While the average childbearing age is going up (in part due to costs of living that make having kids in your 20s really challenging), people under the age of 26 do in fact want to establish families and have kids. Some of those people can’t really afford to spend tens of thousands of dollars on labour and delivery costs, whether for vaginal births or C-sections, especially when those costs spike because of complications. Home births or births in birthing centers can be substantially less expensive, but they are not for everyone, and people shouldn’t feel pressured into a potentially unsafe or unwanted birth experience simply because it’s all they can afford. We don’t expect that people stitch up their own gashes, so why would we tell them they should just give birth at home if they can’t afford hospital births?

The failure to protect pregnant young people is a serious problem, because those glancing superficially at the health care system might assume that the costs of pregnancy are absorbed by insurance companies, making it easy to access adequate maternity care. That’s not the case, and it’s one reason why we have such a terrible mortality rate for pregnant people and neonates. Protecting access to health care throughout pregnancy is critical for the health of pregnant people, and it’s an important aspect of reproductive rights, as well: People shouldn’t feel like they can’t afford to be pregnant, and they shouldn’t fear the associated costs of pregnancy. While thinking about the costs of raising children is legitimate when weighing choices about whether and how to raise a family, the thought that people are flat-out deterred from pregnancy by the simple fact that it’s too expensive to be pregnant is deeply, deeply chilling.

It’s not the kind of society I want to live in, and it shouldn’t be the kind of society you want to live in either.

Image: Pregnant belly behind the grass, Beatrice Murch, Flickr