Democrats: Pregnant women should have special exchange enrollment period

A group of Democratic lawmakers want the U.S. Department of Health and Human Services (HHS) to create a special enrollment period allowing women to sign up for a plan sold on the federal health insurance exchange whenever they find out they're pregnant, The Hill reported.

The problem, lawmakers say, is that the Affordable Care Act created a loophole in maternity coverage. If a woman becomes pregnant when the enrollment period is closed, she can't sign up for a new plan with maternity care because pregnancy isn't considered a qualifying life event.

Without coverage, pregnant women either have to forgo maternity care or pay significant out-of-pocket costs as an average birth without complications costs about $10,000 in a hospital, FierceHealthPayer previously reported.

But insurers oppose this special enrollment. They say it would skew their level of risk to not know how many pregnant members they would have at any given time, making it hard for them to set prices, according to NPR Shots. Plus, they say such an option could provide women an incentive to wait to buy coverage until after they're pregnant.

"If you only create incentives for people to enroll when they have a health need, it poses a tremendous risk to the risk pool and affordability for everyone else," Clare Krusing, a spokeswoman for America's Health Insurance Plans, told NPR Shots.

Despite insurers' concerns, Sen. Patty Murray (D-Wash.) and 35 other lawmakers sent a letter to HHS Secretary Sylvia Mathews Burwell requesting that she take steps to close a gap in coverage that could leave women without access to maternity care.

"Good maternity care is essential for the well-being of children, and studies show that maternal mortality rates are three to four times higher for women who do not receive prenatal care," the lawmakers said. "Millions of women have benefitted from this protection, and we appreciate your leadership in getting this done."

To learn more:
- read The Hill article
- here's the letter to HHS
- check out the NPR Shots article