The Affordable Care Act, Pregnancy Care, Women’s Health and You

Passed in 2012, the Affordable Care Act (ACA) brought about many changes to healthcare in the U.S., including what services are available to pregnant women. The U.S. healthcare system includes a complex web of providers, patients and payers that can be quite confusing. The ACA—a 1,000+ page document is also quite complex and it can be difficult to understand exactly how it impacts you.

Before looking further into what the ACA does for pregnant women, it is important to note that people in the U.S. get insurance in one of 3 primary ways—through their employer (50%), on the individual market (7%), or through public programs like Medicaid or Medicare (36%).1 While some of the changes created by the ACA affect all health insurance plans, the most sweeping changes impacted those buying insurance on the individual market. Here’s an outline of how the ACA helps pregnant women and their unborn children:

Essential Health Benefits for Pregnant Women2
1. Anemia Screening 6. Counseling for Pregnant Tobacco Users
2. Full Breast-feeding Support 7. HIV Screening and Counseling
3.  STI Screening 8. Hepatitis B Screening
4. Gestational Diabetes Screening 9. FDA Approved Contraceptives
5.  Folic Acid Supplements 10. Rh Incompatibility Screening

Preventive Services: Getting care for one’s medical conditions before they worsen leads to better outcomes for the patient and ultimately less health spending. The ACA defined a set of evidence-based essential health benefits that are required to be covered by all insurance plans at no cost to consumers.3 A partial list of these benefits that are beneficial to pregnant women can be found in the table to the right.

Breastfeeding: Complete breastfeeding support was named an essential health benefit under the ACA and therefore must be covered by all health insurance plans with no copay or coinsurance for you. This includes breastfeeding support and counseling from trained medical professionals before and after birth for as long as the mother requires. Additionally, your health insurance must cover the cost of a breast pump, although the specifics (manual, automatic, new unit, rental unit) may vary by health plan. 4

The ACA made changes to the Fair Labor Standards Act requiring that most employers provide reasonable break time as frequently as needed and a private space that is not a bathroom for breastfeeding mothers. The law does not require that these breaks be compensated.5

Coverage for Pre-Existing Conditions: Prior to the ACA, people looking to buy insurance on the individual market could be denied insurance because they were already sick. Despite the fact that pregnancy is a natural and necessary part of life, women could be denied coverage because of their “pre-existing” condition. Under the ACA, it is illegal for virtually any insurer to deny a woman insurance because of her pregnancy status. As soon as a woman is enrolled, benefits for prenatal care, delivery and childbirth become covered benefits. In some circumstances, coverage of these benefits can begin retroactively the day the woman gave birth.6 The extent of this coverage, including copayments, coinsurance and deductibles, will vary by health insurance plan.

Mental Health & Substance Abuse Coverage: Pregnant women may require a range of mental health services, such as substance abuse treatment or counseling for postpartum depression. The ACA stipulates that mental and behavioral health services be offered as part of all plans sold on the individual market. All insurance companies that offer mental health coverage must offer this care with no more restrictions than those applied to more routine medical services.7 Additionally, depression screening is an essential health benefit for all insurance plans and must be covered at no copay or coinsurance to you.

The ACA made many changes to the U.S. healthcare system, including what services are available to pregnant women. For more information on the ACA visit: www.healthcare.gov  Or for information on finding a healthcare provider, visit our online provider database at https://www.resourcehouse.com/hmhb/