Seema Verma, an Indiana health consultant and bureaucrat nominated by President Trump to run Medicare, Medicaid and the Affordable Care Act, put in a word for individual choice on health insurance benefits during her confirmation hearing last week.
The topic, raised by Sen. Debbie Stabenow (D-Mich.), was whether maternity benefits should continue to be mandated for all policies sold under the Affordable Care Act. Verma said the answer is no.
"Some women might want maternity coverage, and some women might not want it or feel that they need it," Verma said. "I think it's up to women to make the decision that works best for them."
With these words, Verma demonstrated either utter ignorance about how health insurance works, or such desperation for this job that she's willing to profess ignorance and paper it over with conservative shibboleths about "individual choice" and the freedom to make one's own decision. She deliberately overlooked that prior to the ACA, there was no such freedom, and women were typically not given a practical choice of whether to take maternity benefits or not; they simply weren't offered.
Either way, she showed herself to be stunningly unqualified to run the nation's two biggest health insurance programs and oversee the Affordable Care Act marketplaces. (Her formal job title would be administrator of the Centers for Medicare and Medicaid Services.) The exchange between Stabenow and Verma from the confirmation hearing before the Senate Finance Committee can be seen below and also viewed here.
The ACA mandate that all individual health plans include maternity coverage as a minimum essential benefit often is ridiculed by conservatives as an example of Obamacare's regulatory overreach.
Typically, you'll hear from males, or women well beyond childbearing age, that there's no way they're gonna have a baby, so why should they pay for the insurance? The question often elicits knowing guffaws, of the type you'll hear in a barroom. Back in the dawn of ACA coverage, we reported on one such exchange initiated by then-Rep. Renee Ellmers (R-N.C.) during a congressional hearing.
"To the best of your knowledge, has a man ever delivered a baby?" Ellmers asked Kathleen Sebelius, then the secretary of Health and Human Services. The deep thinkers over at Breitbart seemed to think this was a slam-dunk, let-me-hear-a-rimshot punchline. "Ellmers was on her 'A' game," they wrote.
Anyone knowledgeable about health insurance saw it differently — as a marker of someone who knows nothing about the subject. So let's recapitulate why pregnancy and maternity coverage need to be a universal, mandatory benefit.
First, while no man has ever delivered a baby, no baby ever has been born without a man being involved somehow. As we observed in the past, if you limit maternity coverage to only women of childbearing age, you're giving many of these guys a free pass. You're placing the entire financial burden of propagating the species on the shoulders of women roughly 18 to 38.
Second, society has a vested interest in healthy mothers and newborns. Unhealthy babies and mothers impose a cost on the entire community, as a squandering of human capital and a generator of costs for treatments that often would have been unnecessary if mothers got the care they needed during pregnancy.
That points to the most important reason for including maternity care as a mandated benefit: Unless the coverage is universal, women won't be able to get it. Prior to the ACA, when insurers could exclude medical conditions from coverage at will, only 12% of policies in the individual insurance market offered maternity coverage. Those that offered the coverage often did so as separate riders imposing huge deductibles of thousands of dollars for maternity care alone, as well as benefit caps of only a few thousand dollars, often not enough to cover the cost of a routine delivery, not to mention complications.
That's one reason women were systematically charged more for health insurance than men, if not the only reason. Prior to the ACA, according to the Center on Budget and Policy Priorities, women were routinely charged more than men — often much more — even for policies that excluded maternity care.
The ACA was designed to eliminate this problem via cross-subsidies: Those who don't need or use a given benefit help cover those who do. What's invariably overlooked by those who whine about maternity coverage is that almost everyone with health insurance is being subsidized for something by someone else. Female policyholders pay for prostate or testicular cancer treatments, which they'll never need. Those with a family history of cancer are subsidized by those without it. Those with dangerous jobs or hobbies — pilots, loggers, hang gliders and scuba divers could be flatly rejected for coverage before the ACA — are subsidized by those who work behind a desk or get their relaxation from collecting stamps.
Verma is best known as an architect of Indiana's Medicaid expansion program, which under Republican Govs. Mitch Daniels and Mike Pence covered the state's low-income citizens with a premium fee of up to 2% of their income.
Verma appeared to be totally blind to this reality. Under Stabenow's questions, she resorted again and again to the notion that women should be "able to decide what benefit package works for them. … I support Americans being in control of their healthcare and making the decisions that work best for them and their families."
"Should we as women be paying more for healthcare because we're women?" Stabenow asked.
"I think that women should be able to make the decisions that work best for them," Verma replied.
"But if the decision is made by the insurance company as to what to charge, how do we make that decision?" Stabenow shot back. "Prior to the Affordable Care Act," she observed, "about 70% of the insurance companies in the private marketplace didn't cover basic maternity care, and basically looked at women as being a preexisting condition. … And that's changed now."
Stabenow put her finger on the basic fatuousness of Verma's position. Before the ACA, women didn't have the ability to make the "decisions that work best for them" because they had no options. Americans then were not "in control of their healthcare," but rather under the thumb of insurers who could exclude or surcharge them for virtually any reason they chose. The Obamacare repeal proposals advanced by Republicans in Congress would return us to that primordial swamp.
The very notion that everyone should be free to pick and choose what conditions they wish to be insured against runs fundamentally against the grain of the very principles of health insurance. If the only purchasers of maternity coverage were women who expected to have a child, then obviously insurers would charge them a price that reflected that choice and included the risk of complications. In other words: Those women would be uninsurable.
Verma continually assured Stabenow that "as a woman," she opposed discrimination against women in healthcare. But by hiding behind Republican catchphrases about choice, she demonstrated a lack of commitment to ensuring that women have real choice.