This post is part of a series of blogs illuminating aspects of racial equity in childbirth and highlighting promising practices to ensure access to a safe, empowering, healthy, and positive birth for all people.
This post has been written by Katy Kozhimannil as part of a collaborative research partnership with Rachel Hardeman and Rebecca Polston, supported by the Robert Wood Johnson Foundation's Interdisciplinary Research Leaders Program.
This week, the US Senate plans to vote on one or more versions of a healthcare bill to repeal and replace, or just to entirely repeal, the Affordable Care Act (also known as Obamacare). The Congressional Budget Office has estimated that approximately 22 million people would lose health insurance under the former, and 32 million would lose insurance under the latter. Medicaid would suffer enormous fiscal cuts, threatening health insurance access for millions of our nation’s most vulnerable people, including half of all pregnant women, who currently receive health insurance through Medicaid.
As we pointed out in a prior blog post, when moms have health insurance coverage, their babies are more likely to survive. Health insurance coverage prevents infant mortality. Let’s remember that this week, and remind those who are making important policy decisions.
However, it’s not just Senators that make crucial decisions that affect the health of moms and their babies. The coverage and benefits design decisions that health plans make, under the regulatory framework set up by law, matter. And we may be entering an era of greater flexibility and fewer regulations for state Medicaid programs and managed care organizations serving both public and private payers. With greater choice comes opportunity to make decisions that improve the health of women and infants and promote greater equity in birth outcomes.
Even if not required to do so, health insurers should include maternity benefits in the plans they offer. As mountains of evidence show, health insurance during pregnancy is important for maternal and infant outcomes.
If maternity benefits are included in high-deductible plans, it is important to grant deductible exemptions for the high-value services women need during pregnancy. This key element of value-based insurance design is not currently being discussed in proposed policy changes, which is a missed opportunity. With deductible exemptions for routine prenatal care and services, high-deductible plans do not decrease utilization (though they still increase out-of-pocket costs). Being aware of the health and financial impacts of cost sharing on childbearing women and families is important, as high-deductible plans will likely increase under any scenario currently under debate in the Senate. Absent major policy changes, such plans will still be prevalent. Each year, a growing percentage of US workers with employer-sponsored insurance report that they have high-deductible plans.
We’ve known for years that when people don’t have to pay out of pocket for a service, they are more likely to avail themselves of it. That’s why health insurance coverage increases access by reducing financial barriers. Health plans should consider both short and long term enhancements to health and well-being that accrue from coverage of reproductive life planning counseling, culturally-competent doula care, community health worker support, birth in out-of-hospital settings (such as Medicaid coverage for care in freestanding birth centers), peer counseling (including breastfeeding and mental health), and postpartum care (including postpartum placement of Long Acting Reversible Contraceptives such as intrauterine devices or implants).
Infant deaths are unimaginably tragic. A clear-eyed focus on preventing these tragedies creates an imperative to meet the medical and psychosocial needs of people who are pregnant. It starts with the most basic policies to support access to health insurance and healthcare services before, during, and after pregnancy. Health plans and others can and should expand on this foundation to ensure greater financial, geographic, and cultural access to evidence-based support.
For now, keeping pressure on legislators to ensure continued access to health insurance should be coupled with a focus on what health plans can do to care for moms, which will help keep their babies alive and improve the health and well-being of families.