The Affordable Care Act (ACA, Obamacare) has improved healthcare options for millions of women by requiring all health insurance providers — public or private — to include maternity care as a standard, non-negotiable part of the coverage. Pregnancy advocates welcome this change but say it isn’t going far enough. They’re petitioning the White House to change the ACA’s open enrollment policy to include pregnant women throughout the year, not just during the limited open enrollment period that lasts for only a few months once a year.
The open enrollment period for 2015 ran from November 2014 through February 2015. That leaves time for a full-term pregnancy between the previous enrollment period to the next one.
The ACA does allow for certain exceptions to the open enrollment period to allow for coverage at any time during the year that specific life-changing events occur: marriage, divorce, change of jobs, and childbirth or adoption. It does not allow a woman to enroll when she becomes pregnant outside the open enrollment period.
America’s Health Insurance Plans
Clare Krusing, speaking on behalf of America’s Health Insurance Plans (AHIP), a trade association that represents the health insurance industry, says allowing enrollment all year long for pregnancy would wreak havoc on insurance premiums for everyone else. The trade association feels year-round enrollment would encourage women to opt out of buying coverage until they became pregnant.
Krusing says the industry uses data from one year’s enrollees to determine premiums for the following year. If women who plan to or might accidentally become pregnant during a given year do not enroll during the limited open enrollment period, the AHIP cannot “estimate accurately the type of care that people will need” in the following year.
The March of Dimes
Cynthia Pellegrini, senior vice president of public policy and government affairs for the March of Dimes, says women should be allowed to enroll at any time of the year they become pregnant. Not every pregnancy ends in childbirth and women who experience miscarriage or loss of pregnancy require medical care that they currently have to pay for out of pocket if they aren’t enrolled during the limited annual open enrollment period. “It is cruel not to cover someone who has complications because of miscarriage,” she said.
US Health and Human Services
Sylvia Mathews Burwell, Secretary for US Health and Human Services, responded to pregnancy advocates meeting in Washington in early February by saying, “A number of the organizations that raise this issue are focused on the same issues we are focused on.”
- Leonard, Kimberly. "Advocates Push for Pregnancy Exception to Obamacare Enrollment." US News & World Report. US News & World Report LP, 18 Feb. 2015. Web. 20 Mar. 2015.
- Pearson, Erica. "Let pregnant women sign up for Obamacare outside open enrollment window, say city controller, state lawmakers." Daily News. NYDailyNews.com, 19 Mar. 2015. Web. 20 Mar. 2015.
- "Pregnant Women." HealthCare.gov. US Centers for Medicare & Medicaid Services, n.d. Web. 20 Mar. 2015.