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/

Breastmilk shown to significantly reduce the risk of infants developing Celiac disease

Breastmilk has been shown to significantly reduce the risk of an infant developing celiac disease, a gastrointestinal condition characterized by gluten intolerance that affects an estimated 3 million Americans.1

Research published by the American Academy of Pediatrics (AAP) shows that “there is a reduction of 52% in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure.”2 In other words, this research shows that to reduce the risk of developing celiac disease, breast milk needs to be in the stomach of the baby when foods with gluten are first introduced.

Babies should not have solid food until they are six months old.  Therefore, breastfeeding the baby until at least six months old is needed for this particular benefit.

Aside from the risk reduction of celiac disease, breastmilk has many additional benefits. Other health benefits of breastfeeding include reducing the risk of sudden infant death syndrome (SIDS) by 36%, ear infections by 50%, lower respiratory infections by 72%, diabetes by 30%, and obesity by 24%.3

To learn more about the benefits of breastfeeding, see the 2012 AAP Policy Statement and the HMHB 2016 State of the State of Maternal & Infant Health in Georgia.

Tobacco, pregnancy, and the costs of cigarettes

Pregnant women who smoke increase the risk of poor birth outcomes for themselves and their babies. These risks include placental abruptions, low birthweight babies, small for gestational age babies, oral clefts, and certain heart defects.1

Georgia birth certificates show that about 6% of mothers smoke during pregnancy. However, due to the stigma associated with smoking during pregnancy, one study has found that many women falsely deny that they smoke.   Research from Ohio found that only about half of the smoking mothers in their study truthfully reported their smoking status on their infants’ birth certificates; 8.6% of mothers reported smoking in the third trimester of pregnancy on their baby’s birth certificate, but 16.5% had high levels of nicotine in their urine.2 Thus, it is likely that the number of Georgia women who smoke during pregnancy is in reality higher than birth certificate data shows.

Maternal smoking has also been associated with adverse health outcomes for the baby even after birth, including sudden infant death syndrome (SIDS). In 2014, 33% of Georgia babies who died of SIDS or other sleep-related causes had mothers who acknowledged smoking on their infant’s birth certificate.3

Most of our smoking mothers picked up the habit in their youth, as research shows that 90% of smokers began smoking as a teen.4.

An effective way to curb teen usage is through a higher price for tobacco products. When the cost of cigarettes increase, the demand for cigarettes decreases, particularly among teens.5

One of the primary ways to increase the price of cigarettes is through taxes. Nationally, the average state tax on a single pack of cigarettes is $1.69. Georgia has only a $0.37 tax on a single pack of cigarettes, less than all states except Virginia and Missouri. Furthermore, Georgia has not increased its tobacco tax in over 10 years.6 Raising the tobacco tax in Georgia would deter teens from ever picking up their first cigarette and could even reduce demand among adults, ultimately reducing the number of babies born to smokers, giving them and their mothers healthier lives.

2016 State of the State of Maternal & Infant Health in Georgia Report Published

Atlanta, Georgia – September 29, 2016 – Today, Healthy Mothers, Healthy Babies Coalition of Georgia (“HMHB”) publishes their second State of the State of Maternal & Infant Health in Georgia report.

As a service to many interested private and public stakeholders, HMHB has summarized pertinent health data in the following areas: prenatal care, fetal mortality, live births, premature and low birthweight babies, infant mortality, maternal disease, maternal obesity, maternal use of alcohol and illicit drugs, maternal mortality, postpartum visits, perinatal mood and anxiety disorders, and breastfeeding. An executive summary and the full report can be found online.

“The goal is to illuminate where we have been, where we are now, and what we can do through collaborative action,” said author and HMHB Board member, Merrilee Gober, RN, BSN, JD. “The current state of Georgia’s maternal and infant health presents ongoing challenges as well as signs of promise for the future.”

“Based on the most current data available, there is reason to be hopeful as teen pregnancy rates continue to improve and Georgia continues to beat the national averages for maternal smoking, alcohol and apparent illicit drug use during pregnancy,” shared Gober.

Areas of challenge include unintended pregnancies, the prevalence of low birthweight infants, maternal mortality and duration of breastfeeding. The report demonstrates that there are often disparities by age, education, race/ethnicity, geographic location and insurance/payment type.

HMHB concludes this report with recommendations in four key implementation areas: (1) prenatal care; (2) legislation; (3) public/private partnerships, and (4) data collection and needs assessment.

“The evidence-based recommendations aim to improve the accuracy of future data as well as the health outcomes for many of Georgia’s mothers and babies,” explains HMHB executive director, Elise Blasingame. “It is critical that we work in partnership to address these issues throughout Georgia. We hope this report will serve as a catalyst for that important collaboration.”

Since 1973, Healthy Mothers, Healthy Babies Coalition of Georgia has served as the statewide voice for improved maternal and infant health and access to healthcare.