Covering maternity care in California

Every American has a stake in the quality of care that pregnant women receive. Good prenatal care, which reduces the number of premature and low-birth-weight babies, is an extremely effective investment, saving $1.37 in future healthcare costs for every $1 spent.

But who should cover the upfront cost of providing that care? Just pregnant women? Couples who want kids? That’s been the approach of most insurers in the market for individual and small-group policies; they make maternity-related coverage an expensive option if they offer it at all, meaning that the cost of the coverage is borne by the relatively small number of people who choose it. Congress has already decided to change that practice. Last year’s healthcare reform law required insurers to make maternity coverage a standard feature of all comprehensive health policies, starting in 2014. That would spread the cost of maternity care across most privately insured Americans.

State lawmakers, who required all large group insurance plans to cover maternity care years ago, don’t want to wait until 2014. Last month they passed two bills that would require maternity coverage to be included in comprehensive policies as of July 1, 2012. SB 222 would apply to the market for individual policies, and AB 210 would apply to small group health plans. The measures would bring maternity coverage to thousands of women who don’t have it now.

As with any coverage mandate, the bills would raise the cost of individual and small group plans, at least in the short term. The California Health Benefits Review Program estimated that premiums would go up by a little less than $7 a month per policy, for a statewide total of $110 million a year. On the other hand, taxpayers are already covering some of the costs rung up by women with no maternity coverage; nearly 10% of the women in the state’s Access for Infants and Mothers program have private health policies that don’t cover pregnancy. And providing prenatal care to more women will reduce the incidence of premature births, which cost Californians an estimated $2 billion each year.

There’s also an issue of fairness. A woman who can get insurance from a midsize or large employer automatically has maternity coverage. Someone who can’t has to choose between paying for the care herself, seeking help from a state program for low-income women or choosing from a small number of plans with comparatively expensive maternity coverage. In Monterey, for example, researchers found only one such policy out of the 79 available, and it carried a $5,000 deductible.

Rather than waiting for the federal mandate for maternity coverage to kick in — and counting on it not to be repealed — Gov. Jerry Brown should sign SB 222 and AB 210 into law. They promise to improve the health of California newborns in the short run, and to reduce total healthcare spending over the long haul.