Closing a maternity coverage gap

State law requires group health insurance plans to cover maternity care, but there’s no similar requirement on individual plans. Lawmakers tried to close that gap in 2004, 2008 and 2009, passing bills that would have required individual plans to include maternity coverage. Each one was vetoed by Gov. Arnold Schwarzenegger. Now a new version, AB 1825 by Assemblyman Hector De La Torre (D-South Gate), is on Schwarzenegger’s desk, and supporters fear it could meet the same fate.

The state provides maternity coverage for the poor through Medi-Cal, and some private insurers routinely include it in individual policies. Others — most notably Anthem Blue Cross, the largest provider of individual coverage in California — offer maternity coverage as an extremely costly option. For example, a 30-year-old woman who added maternity coverage would almost double her monthly premium and pay thousands of dollars more in deductibles before receiving benefits.

Working-class women have an alternative: a state program called Access for Infants and Mothers, which covers medical services and prescription drugs from the onset of pregnancy to two months after birth. The price is low — as little as $36 a month for single mothers — because state and federal taxes cover most of the cost of the policies (60% of which are furnished by Anthem Blue Cross, whose high rates for individual policies drive many women into the AIM program).

AIM is an important safety net, but it’s an imperfect one. By the time many women without maternity coverage find out about the program and sign up for it, they are well into their pregnancies. According to the federal government, women who receive inadequate prenatal care are three times more likely to have pregnancies that don’t reach full term. And babies born as little as two weeks early are likely to have more health and developmental problems.

Everyone has a stake in the health of pregnant women and their newborns, so it makes sense to spread the cost of maternity care across all insurance policies. The federal healthcare reform law does just that, requiring maternity coverage to be included in all new policies issued after 2014. De La Torre’s bill would apply that requirement to any coverage issued or renewed after July 2011, raising premiums for individual policies by an estimated $8.50 a month. That’s a significant jump, but far less than women seeking coverage from Anthem or AIM pay today.

State health officials have objected to the cost of the mandate as well as the risk that it might encourage women to obtain insurance only after they became pregnant. Addressing those concerns, De La Torre amended the bill to allow insurers to impose up to a 12-month wait before they pay for maternity services. That’s a big concession, and the governor should respond by signing AB 1825.