U.S. Senators Barbara Boxer and Dianne Feinstein are calling on California’s health insurance marketplace, Covered California, to allow women to sign up for coverage when they become pregnant.
Under the current rules of the Affordable Care Act, uninsured women who discover they’re pregnant outside of open enrollment periods can only sign up for coverage once the baby is born. The senators sent a letter to Covered California on Wednesday urging the agency to change the policy to make pregnancy a “qualifying life event” that allows women to enroll in coverage at that time.
“Allowing women to purchase health insurance during pregnancy will increase access to care and has the potential to improve health, save lives, and reduce future health costs,” the senators wrote.
The letter comes a week after a group of Democratic senators called on federal health officials to change the rule at the national level. More than 50 members of the House of Representatives are expected to deliver a similar letter on Thursday.
Christina Postolowski, health policy manager at Young Invincibles, an advocacy group pushing for the new policy, says a change in California could lead the way for the rest of the country.
“California doesn’t have to wait for the federal government to act,” she says. “They can take the initiative and make this change now.”
But health insurance industry groups say this would encourage women to wait until they become pregnant to sign up. That would make it difficult for insurers to assess risk pools and set their prices.
“In order for the system to work, we need a broad range of people participating: people who are not currently using the health system and people who are,” says Nicole Kasabian Evans, spokesperson for the California Association of Health Plans.
Advocates say without the change, many women are forced to pay for prenatal care out of pocket; some may forego it altogether. That could lead to a pregnancy complication going undetected until it became an emergency.
“It puts young women in a very difficult position,” Postolowski says. “If something does happen and they end up in the ER, they could be left with tens of thousands of dollars of medical debt.”
She points out that California has led the nation on other maternity care policies. Before the Affordable Care Act, insurers were not required to offer maternity care in their plans. California passed a state law requiring maternity coverage two years before the Affordable Care Act made it national law.
Postolowski says creating a special enrollment exception for pregnant women would help correct a history of discrimination against women by insurers, including charging women more for coverage or denying coverage to women who have had a cesarean section.
“We think special enrollment would close those final gaps,” she said.
But Kasabian Evans of the California Association of Health Plans says that rules under the Affordable Care Act that forbid the denial of coverage to people with preexisting conditions and require insurers to cover maternity care can only work because the health law also requires all people to have insurance, whether they’re sick or healthy.
“As soon as we start watering down the requirements that people have coverage, it could undermine the goals of health reform,” she says.
Before the Affordable Care Act became law, when people were allowed to sign up for coverage only when they needed it, prices skyrocketed, Evans said.