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The Affordable Care Act and Maternity Care

The Affordable Care Act is working in terms of affordability, access, and quality for women. This includes women who were previously uninsured and those who had insurance that didn't provide them with adequate coverage and financial security. Middle-class women have more security, and many of those who already had insurance now have better coverage. Fewer women are uninsured than before the Affordable Care Act. At the same time, as a country, we're spending our health care dollars more wisely and we're starting to receive higher quality care.

Health insurance coverage is now more affordable and accessible for millions of American women. The Affordable Care Act invests in prevention and wellness, and gives individuals and families more control over their care. In addition, the law addresses disparities in access to quality, affordable health coverage.

Women have unique, and sometimes costly, health and medical needs.

  • Prenatal care and delivery, while essential to the health of both mother and baby, are nonetheless expensive, coming at an average cost of over $20,000 in 2011 for an uncomplicated birth.[1]
  • The Affordable Care Act bans annual dollar limits on essential health benefits in all job-related plans and individual health insurance plans. And thanks to the Affordable Care Act, lifetime limits on most benefits are prohibited in any health plan or insurance policy.

Before the Affordable Care Act, women faced unique challenges in the health insurance market.

  • In 2012, a 25-year-old woman could be expected to pay 81 percent more for health insurance than a man, even for a policy that did not include maternity coverage.[2]
  • In 2011, 62 percent of individual market enrollees did not have maternity coverage.[3]

Improved Benefits for Women under the Affordable Care Act

  • Private plans in the Health Insurance Marketplace as well as most individual and small group plans outside the Marketplace are now required to cover 10 essential health benefit categories, including maternity and newborn care. 
  • The Affordable Care Act also now requires most health plans to cover additional preventive services with no cost-sharing, such as well-woman visits, screening for gestational diabetes, domestic violence screening, breastfeeding supplies and contraceptive services.[4]

Twenty-Two Covered Preventive Services for Women, Including Pregnant Women

Maternity care and childbirth — services provided before and after a child is born — are essential health benefits. This means all qualified health plans inside and outside the Marketplace must cover them. Women get this coverage even if they were pregnant before their coverage starts. Under the health care law pre-existing conditions are covered, including pregnancy.

  1. Anemia screening on a routine basis for pregnant women
  2. Bacteriuria urinary tract or other infection screening for pregnant women
  3. BRCA counseling about genetic testing for women at higher risk
  4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
  5. Breast Cancer Chemoprevention counseling for women at higher risk
  6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women
  7. Cervical Cancer screening for sexually active women
  8. Chlamydia Infection screening for younger women and other women at higher risk
  9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs
  10. Domestic and interpersonal violence screening and counseling for all women
  11. Folic Acid supplements for women who may become pregnant
  12. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  13. Gonorrhea screening for all women at higher risk
  14. Hepatitis B screening for pregnant women at their first prenatal visit
  15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women
  16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older
  17. Osteoporosis screening for women over age 60 depending on risk factors
  18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  19. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  20. Sexually Transmitted Infections (STI) counseling for sexually active women
  21. Syphilis screening for all pregnant women or other women at increased risk
  22. Well-woman visits to obtain recommended preventive services

(Source)

More Information About the Affordable Care Act, Maternity Coverage and Preventive Care

Related preventive services that are covered without cost-sharing requirements include:

  • Breastfeeding support, supplies, and counseling: Pregnant and postpartum women have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Breastfeeding is one of the most effective preventive measures mothers can take to protect their health and that of their children, according to the Centers for Disease Control and Prevention (CDC). One of the barriers for breastfeeding is the cost of purchasing or renting breast pumps and nursing related supplies. The Affordable Care Act requires most health insurance plans to cover the cost of a breast pump as part of women’s preventative health services. These rules apply to Health Insurance Marketplace plans, and all other private health insurance plans, except for grandfathered plans. Go to https://www.healthcare.gov/what-are-my-breastfeeding-benefits/ for more information.
  • Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. It will help improve the health of mothers and babies because women who have gestational diabetes have an increased risk of developing type 2 diabetes in the future. In addition, the children of women with gestational diabetes are at significantly increased risk of being overweight and insulin-resistant throughout childhood.

Break Time for Nursing Mothers

The Affordable Care Act amended the Fair Labor Standards Act (FLSA), which covers most hourly wage–earning and some salaried employees. Many employers are required to help their employees who are nursing moms in two ways:

  1. Workers must be given “reasonable” break time to pump for a breastfeeding child, as frequently as needed by the nursing mother, for up to 1 year after the child’s birth.
  2. Women who need to pump or nurse must be given a private space. This space cannot be a bathroom.

For more information, visit http://www.dol.gov/whd/nursingmothers/.



[1] ASPE Computation using 2011 Medical Expenditure Panel Survey (MEPS).

[2] Danielle Garrett, National Women’s Law Center, Turning to Fairness: Insurance Discrimination against Women Today and the Affordable Care Act, (March 2012). Accessed at: http://www.nwlc.org/sites/default/files/pdfs/nwlc_2012_turningtofairness_report.pdf

[3] http://aspe.hhs.gov/health/reports/2011/individualmarket/ib.shtml.

[4] http://aspe.hhs.gov/health/reports/2014/PreventiveServices/ib_PreventiveServices.pdf

 

Content created by Assistant Secretary for Public Affairs (ASPA)
Content last reviewed on May 13, 2015
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