Does The Affordable Care Act Cover Maternity Costs? Not Necessarily, If You're A Young Mom
Last month, the government gave us a much-needed refresher on the many things most insurance companies are required to cover under the Affordable Care Act. Big on the list of wins for women? Birth control and prenatal care — both totally free. But as a new NPR report just pointed out, there was one tiny little loophole for some women that didn't get a mention: under the ACA, insurance companies aren't required to cover labor and delivery costs for dependents. Translation: women 26 and under who may still be on their parent's insurance when they give birth could be screwed. Actually, really screwed.
As for the price tag on your typical labor and delivery, I'll be honest; it might give you the sweats. According to a study by Truven Health Analytics, a vaginal birth can cost you a cool $18,329, while C-sections run an average of $27,866 sans insurance. And if you want to put those figures into further perspective, the latest numbers from the CDC show that in 2013, 2.6 million women gave birth vaginally, compared to 1.3 million who had C-sections. So, yeah, it ain't cheap. But even if your insurance does cover you when it comes to labor and delivery, it may not cover everything. The same Truven Health study cited that consumers paid an average of $2,244 for a vaginal birth and $2,669 for a c-section. Ugh.
Of course, it's not all bad news; it's not a given that all insurance companies will refuse to pay for labor and delivery costs in these cases — and larger ones may actually be more likely to pay. But the law doesn't currently mandate that they have to, and the data just isn't there yet to tell us how often they do refuse.
And then there's this: while the ACA does cover prenatal care visits, according to the Truven Health study, the actual being in the hospital part is somewhere between 81 and 86 percent of the total cost of childbirth. In other words, if you are stuck with the leftover bill, it's going to be big, and it's going to hit hard — at what is arguably one of the most emotionally and financially stressful times in life. "The payments that are made are highly concentrated in that little window," noted Carol Sakala, director of Childbirth Connection, to NPR.
As you might expect, there are plenty of people who are not so psyched about this news. But aside from every under-26-year-old on their parents' insurance, one of them is Dania Palanker, a senior counsel at the National Women's Law Center (NWLC). She had some pretty strong feelings about the lack of coverage, telling NPR bluntly, "pregnancy discrimination is per se sex discrimination." The NWLC filed a sex discrimination complaint back in 2013 with the Office for Civil Rights of the Department of Health and Human Services, against five different major employers that do not offer pregnancy-related coverage for dependent children. So far, though, there hasn't been any movement.
Still, it's important to keep a few things in mind when taking in this news. For one, there are plenty of awesome things the Affordable Care Act does offer women that we never had before: things like well-woman visits, mammograms, and even refunds on breast pumps. Secondly, the Affordable Care Act is still relatively new, and still in need of reshaping — and unfortunately, that may take some time.
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