The healthcare reform law requires maternity coverage and prohibits discrimination against licensed medical providers, but most health plans exclude services provided by midwives and birthing centers, reported Kaiser Health News.
As births increasingly occur outside of hospitals, more people will have to pay out-of-pocket for these alternative maternity services. In fact, more than 50,000 births occurred outside of a hospital in 2012, including more than 15,000 births that took place at freestanding birth centers, according to a recent report from the U.S. Centers for Disease Control and Prevention.
Although that represents a very small proportion of all U.S. births--only1.36 percent--out-of-hospital births have jumped 70 percent between 2004 and 2012.
Midwifery advocates say the problem is the Affordable Care Act doesn't require insurers to pay for all types of providers that offer maternity care and services, Dania Palanker, senior counsel at the National Women's Law Center, told KHN. Similarly, the ACA prevents insurers from discriminating against providers who want to participate in their networks, but doesn't require insurers to contract with any particular provider.
But advocates praise the alternative maternity services. "Birth centers and certified nurse-midwives have a good record of safety and patient satisfaction and birth outcomes," Cynthia Pellegrini, senior vice president for public policy and government affairs at the March of Dimes, told KHN.
What's more, insurers could save money by covering birthing centers and midwives, because they're significantly les expensive than hospitals--in 2010, an average birth without complications cost about $10,000 in a hospital, but barely more than $2,200 in a birth center, KHN noted.