Saturday, November 23, 2013

Maternity care and ACA

I don't listen to talk radio or watch Fox News so this complaint about Obama care comes as news to me:
Opponents of the Affordable Care Act have settled on a new injustice built into the system: The law mandates that all plans cover women having babies.
Representative Renee Ellmers got the ball rolling at an October 30 House hearing where she pointedly questioned Health and Human Services Secretary Kathleen Sebelius: "As far as the essential health benefits, correct me if I'm wrong, do men not have to buy maternity coverage?" The North Carolina Republican hammered Sebelius from there, ending with, "To the best of your knowledge has a man ever delivered a baby?" Sebelius tried to defend covering maternity care, but it was too late. A "single male, age 32, does not need maternity coverage," Ellmers said.
Plenty of commentators have since argued it's unfair to make insurers cover maternity care. Fox News contributor Kirsten Powers objected in mid-November: "The idea that they think that 50-year-olds should have maternity care is very concerning to me." Writing in The New York Times, Lori Gottlieb (an Atlantic contributing editor) complained that her new individual-market policy would be more expensive and include "maternity coverage (handy for a 46-year-old)"—after she'd intentionally dumped "maternity benefits so that I didn’t have to pay for everyone else’s pregnancies." Harvard economist Greg Mankiw, a former Mitt Romney adviser, asserted: "Having children is more a choice than a random act of nature. People who drive a new Porsche pay more for car insurance than those who drive an old Chevy .... Why isn't having children viewed in the same way?"
On Thursday, Nicole Hopkins, writing in the Wall Street Journal, revived the theme, complaining of a "letter from my mother's insurer [that] promised that the more expensive plan 'conforms with the new health care law'—by covering maternity needs, newborn wellness and pediatric dental care. My mother asked: 'Do I need maternity care at 52?'"
Well, I don't have cancer, so why do I have to pay for cancer coverage? My house hasn't burnt down so why do I have to pay for someone else's house fire with my house insurance? This is just dumb.

Years ago, my son's baby sitter, herself new mother of a baby, found that her 'health insurance' through her husband's job as a newspaper reporter didn't cover maternity care and birth. She was saddled with enormous (at the time) bills she was paying off a little each month. At the time, I didn't comprehend that some health insurance didn't cover having a baby. Thirty years later, I find out that until ACA, it still didn't. Garance Franke-Ruta continues:
 But uninsured women of childbearing age weren't making choices between a Porsche and a Chevy in the pre-ACA world. They were trying to find a bus in sprawling towns where they had to walk while everyone else drove. According to the New York Times, in 2011, 62 percent of plans in the private market did not cover maternity care at all. The National Women's Law Center, looking at a narrower slice of the population, found that in 2009, only "13% of the health plans available to a 30-year-old woman" across the country in the individual market covered maternity care—and "in the capital cities of nearly half of the states there was not a single plan available through that covered maternity care." Insurers were also allowed to reject pregnant women from coverage for having a pre-existing condition (pregnancy), and to exclude women who'd had a Cesarian section from coverage entirely (since they'd be at risk of needing another if they were to have another kid).
Do Fox News types not understand that the whole point of insurance is to spread and share risk? I guess the word 'share' doesn't compute.


  1. A Fox News type would probably say that families and those interested in having children should buy into pools composed of similar groups. "My house hasn't burnt down so why do I have to pay for someone else's house fire with my house insurance?" isn't the best analogy. More accurate would be "My house hasn't burnt down, so why do I have to pay for someone else's boat?"

  2. Analogies are always imperfect matches (since otherwise analogs would be identical) but the basic idea of insurance is to spread risk even though different parties face different risks: some houses face greater risk of fires, others of storm damage. The insurance pool is a way of smoothing those. With respect to health insurance, it strikes me that the analogy between pregnancy/maternity care and cancer/oncology care comes closer: if I recall correctly, 1 out of 3 people will have cancer at some point, which means that the 2 out of 3 people who end up without cancer 'pay' for other people's oncology treatment.

  3. The point is that you have more control over whether you have a child than whether you have cancer.

  4. Not that much control with abortion being so hard to get these days.

  5. Now we just need to work TEPCO in somehow.