Time To Deliver: Pregnancy And The Affordable Care Act

Introduction

This month marks the five-year anniversary of the Affordable Care Act (ACA)—President Obama’s signature health care law that has brought quality, affordable care to millions of Americans, while helping to bend the cost curve of health insurance across the country.

Nationwide, nearly ten million previously uninsured individuals have secured coverage. Here in New York, the effects of the ACA have been nothing short of remarkable. Since its inception in 2013, over 2.1 million New Yorkers have secured insurance on our health exchange—New York State of Health, with 88 percent of these individuals reporting being previously uninsured.

While there is much to celebrate in the ACA’s success, there are also several significant gaps in the law that jeopardize public health and the public fisc. This report by New York City Comptroller Scott M. Stringer focuses on one such gap: the inability for women who become pregnant to sign up for coverage outside of the open enrollment period.

Under current law, many women are faced with the untenable choice of spending tens of thousands of dollars out of pocket to secure prenatal and maternity care, or proceeding to term without any care at all.

It doesn’t have to be this way. The ACA recognizes a list of “qualifying events” that trigger an individual’s right to access coverage outside of the open enrollment period. Pregnancy should be added to this list.

The U.S. Department of Health and Human Services (HHS) recently announced that it would not add pregnancy to the Federal Exchange as a qualifying event in 2015, despite the fact that 37 Senators and 54 Members of Congress urged them to do so in a joint letter. Signers included Senators Charles Schumer and Kirsten Gillibrand and Representatives Jerrold Nadler, Carolyn Maloney, Charles Rangel and Gregory Meeks.

While all Americans deserve access to affordable, high-quality prenatal care, New York State does not need to wait for the Federal Government to act. Indeed, several states, as well as the District of Columbia, have taken concrete steps to expand the number of qualifying events for special enrollment periods.

New York should join this group and also become the first state in the nation to designate pregnancy as a qualifying event outside of the open enrollment period, making all women immediately eligible for coverage as soon as they become pregnant. More immediately, the New York State Department of Health (DOH), which is responsible for operating the state’s health insurance exchange, should enact a regulation finding that pregnancy is an “exceptional circumstance” under the ACA, which would allow pregnant women to sign up for insurance during a special enrollment period.