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What the Affordable Care Act Means for Pregnancy

Posted by Administrator to Pregnancy
healthcare pregnancyBig news from the Supreme Court of the United States today: the Affordable Healthcare Act was declared constitutional. It’s a sea change for our country, because now we’ll all be required to buy into a health insurance policy of some kind.

Much more than the individual mandate, however, the Affordable Care Act has a lot of other health insurance changes in it. Many major elements of the legislation, passed in 2010, will have very direct implications for women and children, including mothers, pregnant mothers, and women who don’t yet want to be mothers.

Let’s Have a Baby—Or Not. What the Affordable Care Act Means for Pregnancy

Since the Great Recession, women have been slowing down on having babies. Sure, children are expensive, and that's part of the reason. With the need or desire to have bigger, more kid-friendly living spaces, and with the housing market so unstable and mortgages so hard for people to get, the inability to move could be a contributing factor in birth rate declines, too. But what about all the people who lost jobs or are under-employed and working without health insurance?

Who wants to get pregnant and have a baby without having health insurance?

Now that we’ll all have to have health insurance, will that mean more women get pregnant? Could be. On the other hand, some parts of the Affordable Care Act could make it easier for women to avoid getting pregnant. Take a look at what the law has in it to affect pregnancy in the United States.

More Women Will Have Health Insurance

According to "Why the Obamacare Decision is Very Good News for Women," by Bryce Covert at Forbes, 19 million women don’t have health insurance. (For the record, I'm one of them.) Now, we’ll all be able to have it, including more than 10 million low-income women who will get it through Medicaid, starting in 2014.

As someone who’s gone without health insurance, I can tell you that not having it is not only nerve-wracking, but also health-impacting. If I have health concerns, I ignore them, hoping they’re not serious. That’s not a recipe for a healthy life and that’s no way to exist before, during or after pregnancy. Knowing you’ve got guaranteed health insurance coverage takes a big worry off your mind about how to pay for prenatal care, birth, and any newborn intensive care that might be needed. More women with health insurance could mean more babies on the way!

Women Will Save Money on Health Insurance

Until the Affordable Care Act passed in 2010, I didn’t know that for the same policies with the same coverage, women are routinely charged more for health insurance than men. To the tune of about $1 billion more—every year. Again, from Forbes:

The National Women’s Law Center recently found that in states that haven’t banned the practice, over 90% of the best-selling plans charge women more than men, even though only 3% of them cover maternity services. In fact, even when maternity care is excluded, almost a third of plans charge women at least 30% more than men for the same coverage. One plan even charges 25-year-old women 85% more than men.

Effective 2014, it will be illegal for health insurance companies to charge women more than men for the same coverage. This should be good news for every woman, but think about what it means for unmarried mothers (who are 41% of the women having babies) who are responsible for paying their own health insurance. Unmarried women who want to become mothers (or who find themselves pregnant unexpectedly) should be able to have more money in the bank thanks to lower health insurance premiums. For all women and families, though, lower health insurance costs should mean more savings and more cash to put toward planning for babies.

More Women Will Receive Maternity Care

Speaking of maternity care as part of a woman's health insurance coverage, after in the Affordable Care Act takes full effect in 2014, more pregnant women will be able to receive maternity care. No longer pregnant women be denied health insurance and they will be covered for their current pregnancy, too.

As it stands now, if you get pregnant and you don’t have health insurance, you’ll find it next to impossible to obtain health insurance that will cover your new pregnancy. Pregnant without health insurance = reduced prenatal care and increased health risk for both mother and baby. This is an undesirable equation not only for the mothers and babies affected, but for our society as a whole which should desire healthy, strong women and children.

Most of you reading this probably have health insurance already and/or wouldn’t imagine getting pregnant without having health insurance, but before you think this part of the Affordable Care Act doesn’t apply to you, consider these scenarios:
  • What if you were to lose your job, or your husband lost his job, and you had to find another health insurance plan mid-pregnancy?
  • Or, what if you change health insurance providers after you give birth, and find out that your new insurer won’t cover your next pregnancy because you gave birth via cesarean section last time?
  • Or because you were treated for postpartum depression following one of your births?
According to Carol Sakala of Childbirth Connection who cites that same Women’s Law Center report from 2009:

More recently, some insurers have deemed women who had a previous cesarean birth to be ineligible for maternity care coverage, and there are anecdotes of similar practices, such as excluding coverage of pelvic floor problems among women who have had an episiotomy.

Women who have had postpartum depression, sought psychiatric or psychological counseling for sexual abuse, or had treatment for mental illness in the past will also be guaranteed maternity care services now that the Affordable Care Act has been affirmed. I don't know if this means more women will have babies, but I know it means more women will have healthier babies and be healthier themselves.

Birth Control Will Be Covered Without Co-Pay

birth control pillsAs much as condoms are a popular birth control choice, the reality is that the majority of the birth control burden falls on women to bear. Now, thanks to the Affordable Care Act, women’s preventive health care services—including birth control and doctor’s visits to obtain birth control—will be covered without co-pay. Says the Forbes writer, this adds up to more than $11,000 in savings for women over the course of their lives. More women will get more control over their choice about getting pregnant.

This part of the Affordable Care Act not only encourages healthier pregnancies and babies, but also fewer unintended pregnancies.

Breastfeeding Will Be Easier for Working Mothers

I spoke to my sister-in-law yesterday, and in the course of conversation about how things are going for her with her newborn son, she confessed that breastfeeding and pumping are again her biggest challenges this second time around. Breastfeeding is time-consuming in a way that many new moms can't understand or truly prepare for.

My sister-in-law is a schoolteacher, so she’s at home now on summer break, and her second child was born just before her last day of school. Relative to what it was like after her daughter was born during the school year, this new breastfeeding relationship could be considered "easy."

mother feeding babyWith her daughter, she breastfed for a year, which entailed marathon pumping sessions throughout the school day, where she’d duck into the nurse’s office or the bathroom to pump while her students were working independently. She had to find an aide for each day to stay in the classroom for several times a day while she left to pump. The pump was noisy; she needed privacy and felt awkward throughout the process. But my sister-in-law was fortunate that her school’s principal, and the other teachers and aides, were supportive of her desire to breastfeed her baby. Her boss allowed her the space, time and staff support she needed to keep up her pumping at work.

Not all new mothers are so fortunate, but now, the Affordable Care Act helps working new mothers get this same kind of space and time that my sister-in-law has had. If you work for an employer with 50 or more employees, the Affordable Care Act guarantees that you’ll have the necessary breaks you need and a private place—that’s NOT a bathroom—in which to pump for up to one year after the birth of your child.

With only about 30% of new mothers reaching their personal goal of breastfeeding for a mere three months (half of what's recommended by the World Health Organization, the American Academy of Pediatrics and the United States Surgeon General), this is great news. I'm counting on seeing more women and babies benefit from breastfeeding longer as a result of the Affordable Care Act.

Midwifery Care May Become Less “Designer” and the New Normal

Did you read the New York Times story about the trend among affluent, well-educated women seeking midwifery care for pregnancy? The fact is that the number of women seeking midwifery care before, during and after pregnancy has doubled since the early 1990s and is now at an all-time high. It used to be that midwife-attended births were about 4% of the births in the United States. As reported this week by the American College of Nurse-Midwives, the percent in 2009 was just above 8%—and yes, the trend is being driven by well-to-do Caucasian women.

There are numerous benefits to having a midwife tend to your prenatal care, pregnancy planning and childbirth, including:
  • lower likelihood of cesarean birth
  • increased likelihood of full-term babies
  • lower rates of induction and birth intervention
  • lower cost of prenatal care, birth and postpartum care
  • and more.
In many European countries, midwives attend more than 70% of pregnancies and those countries report healthier babies and fewer fatalities and injuries to both mothers and babies. In fact, the United States has one of the highest rates of women and babies dying from childbirth among all the world's developed nations.

In our country, low-income women have faced some barriers to obtaining midwifery care and have thus been denied the benefits of such care. Until the Affordable Care Act, Medicaid did not recognize midwifery care, or birth in a birth center, as reimbursable. And Medicare, while it did reimburse midwifery services, did not reimburse at 100%. Nurse-midwives and certified nurse-midwives would face financial hardship themselves because they wouldn’t be able to get full payment if they took on Medicare clients.

Effective January 1, 2011, those policies changed under the Affordable Care Act, and now that the law has been upheld, more midwives should begin to be able to offer their services to more low-income pregnant women.

As a woman who used a certified nurse midwife for my prenatal care, birth, postpartum care and preventive health checks, I can’t say enough how excited I am that this law could extend the role that nurse midwives have in US maternity care.

The bottom line: the Affordable Care Act will make it more likely that women can afford to get pregnant, obtain adequate prenatal care, obtain health care for their newborns, breastfeed longer, get postpartum health care, benefit from midwifery care and obtain birth control. This should prove to be a boon for all women, children and families, but especially for unmarried women who either want to achieve or avoid pregnancy, low-income women, and women who want healthier, safer babies.

Written by Maternitique founder and CEO, Tara M. Bloom. I look forward to your comments, pingbacks and seeing who shares this on Facebook, Twitter, Tumblr, Google+ and StumbleUpon.

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