Changes in the current health insurance marketplace are likely coming. Here's our summary of what is currently offered under the Affordable Care Act for pregnancy and the postpartum period, and what changes will likely occur under the new administration.
Breastfeeding benefits under ObamaCare:
1. Health insurance must cover the cost of a breast pump.
2. Breastfeeding support and counseling must be covered by health insurance before and after birth, and must be covered for the duration of breastfeeding.
3. The ACA amended the Fair Labor Standards Act to protect breastfeeding moms who need to pump at work. The ACA required that employers with at least 50 employees must allow the time and a space--"other than a bathroom, that is shielded from view and free from intrusion by coworkers and the public"--for a mother to express breast milk for the first year after the birth of her baby. The law only applies to hourly wage employees, not salaried workers.
What might change:
1. Before the current healthcare laws, pregnancy could be classified as a pre-existing condition, and therefore maternity care and childbirth coverage could be denied by insurers. Currently, maternity care and childbirth must be covered by all insurance plans, even if the pregnancy began before coverage started.
2. The birth of a baby means that you are eligible for a special enrollment period, meaning you can enroll your newborn in a health insurance plan at any time and coverage will begin from the date of birth, rather than having to wait for the open enrollment period.
3. Medicaid expanded under the Affordable Care Act, making it accessible for a broader range of incomes and circumstances. Under Medicaid, a long list of prenatal and postpartum care is available without cost to the individual, including: birth control and family planning services, screening for gestational diabetes, HIV and sexually transmitted infection screening and counseling, interpersonal violence screening, and breastfeeding support.
4. The ACA put limits on out-of-pocket expenses, meaning that high-risk pregnancies and infants who need hospitalization and intensive care are less likely to create insurmountable cost burdens for families.
5. Lower- to moderate- income families are eligible for premium tax credits if they do not qualify for Medicaid or for coverage through an employer and they have coverage under a qualified health plan. Under the ACA, if a woman becomes pregnant and is therefore eligible for Medicaid coverage, she will not lose her premium tax credit.
What might change:
1. All qualified health plans must include family planning and contraceptive care at no cost to the individual.
What might change:
Other benefits specific to women that might change:
1. Well-woman check-ups, and preventative screenings for breast cancer and cervical cancer must be covered with no cost-sharing (no deductible, co-pay, etc.)
2. "Gender rating" (charging women higher premiums than men for their health insurance) is prohibited under the ACA.
3. Mental health benefits, including treatment of postpartum mood disorders such as postpartum depression and anxiety, postpartum OCD, and PTSD, are included in "essential health benefits" and must be covered by qualified health plans. Previous mental health issues cannot be grounds for denying coverage, and for most plans there can be no caps on the number of covered visits for psychotherapy.
Maternal health matters to us all. Let us hope that the majority of American women have access to quality affordable healthcare, including maternity care, childbirth coverage, routine preventative screenings, and mental healthcare in the future.