Let’s Not Throw the Baby Out with the Bathwater, Okay?

Image courtesy of John Griffiths.

This week, a lot of strange things took place on Capitol Hill.  A strange, archaic way to pass bills was used to call for a motion to open debate on a bill.  Various versions of “reform” were trotted out for the “Obamacare Crisis”.  One version would have removed health coverage from an estimated 30 million people and the other would have left 16 million uninsured. The Affordable Care Act (ACA) has issues.  Healthcare in America has serious issues.  However, health care is a feminist issue.  As a political scientist, I can tell you common knowledge would show you the issue of health care is dead.  However, this game of legislative whack-a-mole is leaving me exhausted.  Today, I’m going to address why you should still be invested in health care and why you should stay proactive to protect important parts of the bill which would have been removed under at least one of these proposed bills:

Ten Reasons the Affordable Care Act has changed things for the better – especially for women:

  1. Your private plan is required to cover maternity services if it is through your employer or the exchange (private plans on the market outside that exchange may vary).  Before the ACA, all private plans and employer plans could choose not to cover maternity services leaving women to completely pick up the bill.  What does a birth cost?  In 2008, the federal government estimated the average total cost for an uncomplicated vaginal delivery was almost $10,000 out of pocket and an uncomplicated cesarean delivery was $15,800.00.  WebMD finds that the average woman will pay $2,000 out of pocket for prenatal care on top of that.  NICU stays, complications, and anesthesia are extra.  So, not having coverage is catastrophic for most families.
  2. Your private plan is required to treat you the same as a man – you should pay the same.  Prior to the ACA, women paid more for coverage than men.  Controlling for whether plans offered maternity benefits, 60% of insurance plans on the individual market charged women more than men for the same benefits.  Now, no plans sold in the U.S. can charge women more than men (even if they don’t offer maternity coverage on the individual market).
  3. There is no lifetime max of benefits.  Prior to the ACA, there was a $1 million or $2 million dollar lifetime maximum that your insurance would cover.  The March of Dimes estimates preemies cost about $50,000 in the NICU.  In many cases, pre-30 weekers can cost more than $100,000 and many babies will require ongoing care that costs even more.  Imagine being half way to your lifetime maximum when you are just 10.  That is not good for moms or babies.
  4. Pregnancy is not a pre-existing condition (nothing is).  Before, you could be denied coverage for conditions which arose during pregnancy.  Got a heart condition?  It’s not covered.  Got high blood pressure from pre-eclampsia? Not covered.
  5. Your birth control is covered.  Prior to the ACA, I was lucky enough to have insurance but my insurance coverage for birth control was week.  It cost me over $300.00 to have my first IUD inserted and the same for a birth control implant.  It also cost about $400.00 a year for my birth control pills – generic pills – before that.  And the only reason all of this was covered was because it was medically necessary with my endometriosis.  If you had no insurance, you would have paid $2400.00 for an IUD out of pocket.  Since so many people rely on birth control to plan their families according to desire and financial constraints, contraception that is affordable is a must for any society.  Likewise, the most effective way to address contraception is through extended access to care.
  6. Women’s health benefits are essential health benefits.  This means your pap smear, mammograms, and yearly GYN visits are covered.  This was not the case before.  In fact, all preventative services would have counted towards your deductible and/or copay.
  7. Well-baby services have to be covered.  This is considered another “essential” health benefit.  My kid’s shots and checkups are 100% covered.  This means kids get the best start.
  8. Women’s health services are not under fire – they are empowered.  Under this new so-called “Skinny” repeal, sliding scale providers would not have been offered any federal funding for services if they also provided abortions anywhere in their health network.  This bill was only 8 pages long.  Take it from someone who knows, that is a short bill.  Almost a page and a half of that bill was an attack on Planned Parenthood and other such providers.  Because the ACA provided funding for these services and considered them preventative care and “essential” for the first time in history, more women are getting much-needed care.
  9. Medicaid expansion has positively affected the lives of women and their babies.  I’ve written about this in-depth but Medicaid is essential here.  Medicaid expansion has helped more low-income women get continuing care.  Since they are the most at risk for complications, Medicaid positively impacts the health outcomes of women on it in a comparable way to the benefits women receive from private insurance. Medicaid also provides for women to give birth in hospitals rather than choosing to have higher-risk pregnancies lead to birth at home, something that became more common during the period of uninsurance which existed prior to the ACA’ passage. Babies, too, benefit, as children have better outcomes on Medicaid than children without insurance and comparable outcomes to those on private insurance.
  10. Your breastfeeding services are covered.  You are eligible for breast pumps and your right to breastfeed at work if you work at anything but a very small employer is protected.  You have the right to a break and a place to pump that is not a bathroom.

The ACA is not perfect.  I, myself, would argue that a two-tiered system with a single-payer base system and a private system outside of that would allow citizens the best choice and access to care.  When I lived in the U.K., my health care was free and my scripts were cheap.  I did not ever worry.  Even when I required an ambulance ride to a hospital for endometriosis pain that was out of control, I didn’t pay for it.  Still, throwing out the baby with the bathwater (unless we are moving to a single-payer system which is about the only option remaining) is not going to fix health care access.  Millions more will be without care.  Millions more will flood ER’s for treatment because it’s all they can be guaranteed as a right.  That will cost more and drive up the cost of care for all in tax dollars and premiums.

So, while it may seem things are over, I’m not convinced. In the world before this, one would assume health care as a policy area was dead and struck out of the policy cycle.  However, with this Congress, this seems to be a strange ride on a crazy train.  If you care about maternity care, access to care, Medicaid, breastfeeding, or the worries about NICU bills of parents, call your representatives.  And don’t forget the state level.  Medicaid expansion is still on the horizon. For states without it, let your legislators and governor know you want it.  For states with it, tell your people you want to protect it and make it even better.

Policy options are not silver bullets.  That’s not the intent.  Nevertheless, we deserve health care as 50% of the population.  Since motherhood is a common stage in the lives of many women, we should support those services as essential ones and since breastfeeding is a feminist issue, we should fight for those rights. Likewise, we should ensure all women have access to contraception options – both short and long acting – so that they can choose when their babies arrive or choose to be childfree.


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