As OE2 comes to a close, we are thinking more and more about the particulars when it comes to Special Enrollment Periods (SEP) and who may qualify in the upcoming months. SEPs provide an opportunity for individuals to enroll in health insurance after a major life-changing events such as getting married, moving, losing a job, and having a baby—twenty organizations are now lobbying the Administration to include pregnancy as one of these qualifying events. Here’s why:
When a child is born, the mother qualifies for an SEP, but this coverage comes after all of the crucial prenatal care and check-ups essential to a healthy pregnancy for both mother and child. Young Invincibles stated in a recent report that maternity and delivery costs without complications range from $10,000-$20,000. A woman without maternity coverage may have to pay for the services out of pocket, or she might choose to forgo these services due to financial constraints. This can be detrimental to the health of the mother and the fetus, in addition to financially devastating an individual who might require healthcare services due to a complication with their pregnancy.
Maternity care can mitigate or prevent health risks associated with pregnancy such as preeclampsia, placental abruptions, diabetes, heart conditions, and Graves’ disease. Without the recommended check ups and screenings, these conditions could go untreated and result in permanent health issues or fatality for the mother or child. In fact, pregnancy-related maternal mortality is 3-4x higher among women who receive no prenatal care compared to those women who do. These severe health risks underscore the importance of access to maternity care.
About 83 percent of new mothers are between the ages of 18-34. Health risks aside, pregnancy can leave these women in a financially vulnerable position, which might deter them from seeking the prenatal care necessary for a healthy birth process. This has lasting consequences not only for the mother but for the child as well. Considering that half of all pregnancies are unplanned, immediate access to maternity care is critical to the children and parents’ physical, mental, and financial wellbeing. Based on these facts, an SEP for pregnancy seems not only worthy of consideration, but a meaningful investment in the health of our communities.
Young Invicibles lists four key factors in favor of designating pregnancy as a qualifying trigger for SEP, they are
- The high cost of maternity care
- The severe health risks associated with undiagnosed or untreated pregnancy-related diseases
- The continued existence of plans that do not cover maternity care
- Half of pregnancies are unplanned
It is also worth noting that Medicaid currently covers forty percent of all births in the US, but eligibility thresholds for pregnant women vary state to state, and some are considering rolling back coverage for pregnant women. Maternity care is not the place to cut back coverage, since the stakes are high and the consequences severe.
As of Friday with the release of the Benefit and Payment Parameters for 2016, HHS declined to add pregnancy to the list of qualifying life events for SEP. As we strive to improve access to affordable healthcare for people across the country, we should recognize that this change could make a profound impact not only on this generation of mothers, but also on the families and children that will shape our future.
