Health insurance is absolutely critical to ensuring healthy births. Yet in Pennsylvania, maternity care does not need to be included in individual and small group health plans. Important legislation – SB 1063 and HB 1957 – will expand pregnant women's access to insurance in our state and guarantee that pregnancy can no longer be considered a pre-existing condition by insurance companies in determining eligibility for coverage.
Pregnancy as a Pre-Existing Condition: Currently, insurers are able to deny a woman's application for insurance citing pregnancy or a previous C-section as a pre-existing condition. SB 1063 and HB 1957 would ban this unfair practice.
Availability of Maternity Coverage: Most mothers and fathers-to-be are shocked to learn that their insurance does not include maternity. Often, they must purchase maternity coverage as a 'rider' to their regular insurance. This means additional costs that many families cannot afford. SB 1063 and HB 1957 would ensure that all plans include maternity coverage, with a minimum standard of care for each stage of pregnancy.
Insurance as the Gateway: Access to health care services is critical to ensuring healthy pregnancies and positive health outcomes for moms and babies. The gateway to care is affordable insurance plans. By ensuring that maternity coverage is available to all women, we can help foster healthier pregnancies and healthier babies, as well as alleviate the cost associated with emergency care that is far too often a last resort for women who lack access to care.
Currently Pennsylvania has no state law requiring individual or small employer group health plans to provide maternity benefits. Despite federal protections such as HIPPA (Health Insurance Portability and Accountable Protection Act), women who lose or change jobs still risk falling into a loophole of not having maternity coverage if they become pregnant. This is because pregnancy – not to mention C-sections – can still be considered a pre-existing condition by insurance companies in determining eligibility for coverage.
This legal omission has only added to the number of uninsured and underinsured Pennsylvania mothers and families, and increased healthcare costs for everyone. The cost of maintaining the status quo is too great for the state and too great for Pennsylvania families.
Some Startling Facts:
•1 in 8 women in Pennsylvania are uninsured (March of Dimes, 2011).
•35% of women in Pennsylvania receive inadequate prenatal care (March of Dimes, 2011).
•The average national cost of a normal hospital labor is $9,617, with complicated C-section deliveries costing up to $21,495 (Childbirth Connection, 2011).
•For the 12% of women who are currently uninsured – those who lack access to employer coverage, or who earn too much to qualify for a public program – the individual insurance market is often the last resort for coverage.
•6% of women aged 0-64 in PA, or 294,400 women, buy insurance in the individual market (Kaiser Family Foundation, 2010).
•Only 8% of individual insurance plans available to a 30-year-old woman living in PA’s capitol offer maternity coverage (National Women’s Law Center, 2009).
I am asking you to request public hearings and votes for this important legislation. The future health and economic prosperity of the Commonwealth depend on the well-being of Pennsylvania mothers, babies and families. Insurance is the gateway to health care. Every family deserves the assurance of maternity care in their insurance coverage without fear of losing it when they need it most.
I look forward to hearing your thoughts on this matter.