Sen. Sherrod Brown to introduce legislation adding pregnancy as “qualifying life event” for insurance enrollment or changes outside open enrollment period.


By Rachel Lloyd - rlloyd@aimmedianetwork.com



WASHINGTON, D.C. – Sen. Sherrod Brown (D-Ohio) hosted a conference call Wednesday to announce his plan to introduce legislation that would increase access to prenatal and maternity care. Brown’s bill, the Healthy Maternity and Obstetric Medicine Act (Healthy MOM Act) would create a special enrollment period (SEP) so pregnant women can enroll in or change their healthcare plans once they become pregnant.

Brown was joined on the call by Dr. Jennifer Bailit, maternal-fetal medicine specialist at MetroHealth Medical Center, and journalists from around the state of Ohio.

“Women don’t time their pregnancies around arbitrary insurance open-enrollment periods,” Brown said. “These deadlines should not keep Ohio mothers-to-be from getting the care they need. That’s why I’m introducing the Healthy MOM Act – to ensure all women can access affordable health coverage during their pregnancy. This bill is common sense. We should be doing everything we can to ensure Ohio’s mothers and mothers-to-be receive the care that they need to have healthy pregnancies and healthy infants.”

“Early prenatal care is critical to achieving healthy outcomes for pregnant women and their babies,” said Bailit. “Without early prenatal care we cannot adequately fight the unacceptably high levels of prematurity and infant mortality affecting the United States.”

Women who become pregnant during the Health Insurance Marketplace’s open enrollment period – which begins on Nov. 1 – can change or update their plans or enroll in a new plan, but someone who becomes pregnant outside that period cannot because pregnancy is not considered a “qualifying life event.” Some major life changes – like getting married, giving birth, or adopting a child – are considered “qualifying life events” that make individuals eligible for an SEP, when they can enroll in or change their health care plans through HealthCare.gov. Because pregnancy is not currently classified as a “qualifying life event” under current law, some mothers who become pregnant and are unable to change their insurance status may forgo critical prenatal care or pay significant out-of-pocket medical costs – risking the health and safety of both mother and baby.

During the call, Brown cited as an example his daughter, who has good health insurance and good prenatal care and gave birth to a healthy baby less than two weeks ago.

“Every woman in the state should have the same opportunity my daughter did,” Brown said.

The Healthy MOM Act would address the coverage gap by creating an SEP for pregnant women, ensuring mothers have access to the health care options that best fit their maternity and prenatal needs. Specifically, the Healthy MOM Act would:

• Create an SEP in the Health Insurance Marketplace for pregnant women so they can enroll in or change their healthcare plan;

• Enable the Director of the Office of Personnel Management to establish an SEP for pregnancy for those eligible to receive coverage, but who do not currently receive coverage, through the Federal Employees Health Benefits Program;

• Ensure comprehensive coverage of maternity care – including labor and delivery – for dependent children covered by group health plans and other forms of employer-sponsored coverage; and

• Protect existing income eligibility levels for pregnant women and infants covered by Medicaid.

Asked about the cost to insurers, adding a requirement that would guarantee immediate claims on a policy, Brown acknowledged that it would initially cost the insurers money paying out those claims, but added, “We know it will save money in the end. We know it will make healthier babies.”

He said that insurers should see that cost not as an expenditure but as an investment, as they would be reducing their own future costs if babies are born healthier.

“It’s more an investment than a cost,” Brown said. “It will potentially save thousands and thousands of dollars because the babies will be born healthy.”

Brown said studies have shown $1.37 is saved in health care costs for every dollar invested in maternity care.

According to the U.S. Health Resources and Services Administration (HRSA), more than one million babies are born to mothers who did not receive adequate prenatal care each year. Although Ohio’s infant mortality rate has decreased over the past year, the state’s rate is currently 21 percent above the national average and even worse for African American infants, who are 2.2 times more likely to die before their first birthday in Ohio than white babies. Nationwide, maternal mortality rates are three to four times higher for mothers who do not receive prenatal care compared to mothers who do, and babies of mothers who do not receive prenatal care are five times more likely to die and three times as likely to be born prematurely compared with mothers who receive adequate care.

Brown’s legislation will be cosponsored by U.S. Sens. Patty Murray (D-Washington), Barbara Mikulski (D-Maryland), Ed Markey (D-Massachusetts), Jon Tester (D-Montana), Martin Heinrich (D-New Mexico), Tammy Baldwin (D-Wisconsin), Sheldon Whitehouse (D-Rhode Island), and Robert P. Casey Jr. (D-Pennsylvania).

The Healthy MOM Act is endorsed by the following organizations: American College of Nurse-Midwives; American Congress of Obstetricians and Gynecologists; Association of Women’s Health, Obstetric and Neonatal Nurses; EverThrive Illinois; Families USA; March of Dimes; NARAL Pro Choice Oregon; National Health Law Program; National Patient Advocate Foundation; National Women’s Law Center; Maryland Women’s Coalition for Health Care Reform; MomsRising; Ohio Hospital Association; Ohio MetroHealth System; Ohio Public Health Association; and Young Invincibles.

Brown said the Department of Health and Human Services proposed making pregnancy a qualifying life event, but such a change requires legislative action so the HHS did not have the authority under the law to make the change.

By Rachel Lloyd

rlloyd@aimmedianetwork.com