The case for all insurance policies to cover maternity services

Pennsylvania does not require individual or small group insurance policies to cover maternity care. When the Affordable Care Act is fully implemented nin 2014, such coverage will be mandatory for all health insurance plans, but what happens in the meantime?

A friend of mine is about to become a grandma. She’s excited. She’d like to be buying layettes and toys, but instead, she’s paying for her daughter’s maternity care. Her daughter and son-in-law both work in a small business that offers insurance, but not for pregnancy-related expenses.

And this isn’t unusual. Pennsylvania (along with 31 other states) does not require individual or small group policies to cover maternity care. Pregnancy or a previous caesarian-section delivery can be considered a pre-existing condition in determining eligibility for coverage.

As a medical historian, I know that the first studies showing that prenatal care resulted in healthier mothers and healthier babies appeared about 100 years ago. From 1921 to 1929 the federal government, through the Sheppard-Towner Act, funded maternal and child health centers (many of them in rural areas) in response to findings that 80 percent of pregnant women did not receive adequate prenatal care.

A White House Conference on Child Health and Protection held in 1933 identified a lack of prenatal care as one the two most critical factors in maternal mortality. During World War II the government stepped in again and through the Emergency Medical And Infant Care Act funded services for the wives of servicemen in the lowest pay grades.

As prenatal and delivery services improved in the second half of the twentieth century—thanks to many medical advances such as the availability of antibiotics, maternal and infant death rates declined very rapidly. But while we’ve known for over a century that prenatal and maternity care is good for mothers and for babies, we haven’t succeeded in delivering those services to all the women who need them. Over 11 percent of women in Pennsylvania are uninsured.

We incur larger and longer-term costs when women forego vital medical services during their pregnancies and deliveries, putting themselves and their babies at risk. Women know that and they do seek care, but sometimes they put off doing so because they lack insurance coverage and fear the expense. Almost all women lacking insurance coverage give birth in hospitals. After their deliveries they end up with newborn babies and a bill they cannot afford to pay. Ultimately, the cost is borne by the hospital and then shifted along to taxpayers and in the form of higher insurance premiums for everyone else.

Thanks to the Pregnancy Discrimination Act of 1978, women covered by large group insurance plans (15 or more employees) do not face this problem. Nor do women receiving insurance coverage through Medicaid. And in 2014, when the Affordable Care Act is fully implemented, maternity coverage will be mandatory for all health insurance plans.

But what happens in the meantime? How can we get those politicians—the ones who love to kiss babies while running for office and dismiss them once elected—to do something?

There’s an easy answer to that: passing Pennsylvania Senate Bill 1063, which requires all insurance policies to cover maternity services. Grandmas, future grandmas and everyone else needs to call or write their elected officials and speak up on behalf of this bill. It is the best present we can give our future children and grandchildren. And it’s about time, isn’t it?

Janet Golden is a professor of history at Rutgers–Camden and the author of “A Social History of Wet Nursing in America: From Breast to Bottle” (Cambridge University Press, 1996) and “Message in a Bottle: The Making of Fetal Alcohol Syndrome” (Harvard University Press, 2005).