North Carolina Republican tries to tarnish Obamacare for the crime of … mandating maternity coverage!

June 21, 2014

By Matthew E. Milliken
June 21, 2014

A short item that Tara Culp-Ressler posted at Think Progress caught my eye on Thursday.

Mandy Cohen of the Center for Medicare and Medicaid Services, who is due to give birth in about three weeks, recently appeared at a House Oversight and Government Reform Committee hearing entitled “Poised To Profit: How Obamacare helps insurance companies even if it fails patients.”

During her testimony, Rep. Mark Meadows pressed Cohen about a provision in the Affordable Care Act that requires insurance companies to include maternity coverage in all new plans that they sell. The Republican representative, whose district covers the mountainous western corner of North Carolina, asked if there other coverages that insurers must sell (and which ipso facto consumers must buy) because of Obamacare.

Cohen: It depends on your personal family situation and your medical situation. I’ll say as an internist, and a primary care doc, that sometimes you don’t know what that medical situation will be going forward, and that’s the nature —

Meadows: But maternity is one that you can probably analyze pretty well for someone who’s in their 50s.

Cohen: Right, but it’s a minimal essential benefit we wanted to make sure every American has.

If this is going to be one of the GOP’s main points of contention about the Affordable Care Act, then the law could well have a very rosy future. Is it unfair for people (read: men) to pay for coverage that they aren’t going to use? Perhaps so, but that’s also a fundamental component of insurance.

And let’s remember what the health-insurance market was like before Obamacare mandated maternity coverage. The National Women’s Law Center released a study in early 2012 that captured many unsavory aspects of those not-so-good days.

Back then, gender rating — that is, charging women more than men for comparable coverage — existed without restriction in 36 states. Businesses with mainly female work forces were “routinely” charged more than others, the center reported. This disparity affected many hospitals, medical offices, pharmacies, community-service organizations, and home-health-care and child-care businesses, all of which skew female.

But gender rating may have had the biggest impact on the individual market. “Even with maternity coverage excluded, nearly a third of plans examined charged 25 and 40-year-old women at least 30% more than men for the same coverage,” the report stated (emphasis added).

The National Women’s Law Center estimated that because of gender rating, “women spend approximately $1 billion more for health coverage annually than they would if they were men, not counting any additional costs women must pay because of the exclusion of maternity benefits.”

That’s worth repeating: Women paid $1 billion more for health coverage than men, even without counting expenses for maternity care.

Speaking of maternity care, it was hard to obtain for women shopping on the individual market. In the 41 states that didn’t require insurers to offer services to pregnant women, only 12 percent of health plans available to 30-year-old women included this type of care.

Sometimes, the care was offered through riders that were far more expensive than the main plan. In many cases, “maternity riders may include a waiting period (one or two years, for example) before the coverage even takes effect and the actual benefits provided through riders are often limited in scope.”

A 2007 study from the Kaiser Family Foundation noted just how important maternity care is:

With approximately 4 million births in the United States each year, pregnancy and childbirth-related conditions are the leading causes for hospital stays and account for almost 25 percent of U.S. hospitalizations. The cost of having a baby can easily reach thousands of dollars, making insurance coverage critical for pregnant women. Predicting the cost of even a routine, planned pregnancy, however, can be difficult.

The Kaiser report also found that maternity coverage was frequently not sold on the individual market. When available, the level of coverage varied tremendously, with out-of-pocket childbirth costs running anywhere from less than $1,500 to more than $20,000, depending on the plan and the details of the pregnancy. (Most of the tabs hovered between $6,000 and $9,000.)

Further, the study noted,

The details of a plan’s coverage for specific services are not always apparent, making it very difficult to estimate spending accurately. Investigating the details of plan coverage for unpredictable health care needs, such as pregnancy complications, is even harder for consumers.

By the way, Meadows is right that 50-year-old women rarely become pregnant by natural means. Still, it does happen, and the risks of complications for mother and child are significantly higher among women 35 and older. (One in 10 25-year-olds experience miscarriages, a rate that rises to one out of five 35-year-olds and half of 40-year-olds.)

Once again, if the standardized inclusion of maternity coverage is really a key weapon that critics are trying to wield against Obamacare, that suggests that opposition to the program is spinning down.

After all, evidence is mounting that — despite the abysmal launch of the website — the law seems to be working as designed. A recent federal report stated that tax credits included the Affordable Care Act seem to have helped make health insurance more, well, affordable. About two-thirds of customers who purchased plans on the marketplace using health credits had monthly premiums of $100 or less after accounting for government assistance; 46 percent paid $50 or less after getting tax credits.

Competition may also be placing downward pressure on premiums. More than four in five eligible marketplace customers were able to select plans offered by from three to 11 health insurance companies; at least two insurance issuers are selling coverage nearly everywhere in the country.

It remains early days yet, but a newly announced survey of nearly 60,000 young adults conducted by two Harvard researchers attributed a number of positive effects to Obamacare. The law’s provision mandating that offspring up to age 25 remain eligible to be covered by their parents’ health plans increased insurance in that age group by 7 percentage points. Out-of-pocket health-care spending in this population dropped thanks to the expanded coverage.

For reasons that aren’t clear — there was no discernible increase in utilization of health-care services — the amount of people in the survey who self-reported being in excellent physical health rose by 6 percentage points, and those who said they were in excellent mental health rose by 4 points.

“The health insurance that people are gaining seems to be doing what it is supposed to do,” Dr. Kao-Ping Chua, a pediatrician and the lead author of the study, told The Los Angeles Times.

Meanwhile, few if any of the dire predictions made by critics of the Affordable Care Act have been realized. A new paper published by the National Bureau of Economic Research found that average prices for individual health insurance buyers rose 14 to 28 percent between 2012 and 2014, the first year Obamacare plans took effect. The authors attribute insurers’ price hikes to “expectations of a higher risk population being enrolled” — which was, you may recall, a key goal of the Affordable Care Act!

The price increase in the NBER study, mind you, doesn’t account for tax credits, meaning that the pocketbook impact for many individual is much lower than the rates calculated by the researchers. Matt Yglesias of Vox cites federal data indicating that the average federal marketplace shopper is getting a monthly tax credit of $264.

As Yglesias and Kevin Drum of Mother Jones observed this week, the Affordable Care Act — which, remember, was modeled after a program enacted in Massachusetts under Gov. Mitt Romney — is functioning as expected.

That certainly doesn’t mean that the law is perfect, or that it’s all going to be smooth sailing from here, or that we don’t need to continue evaluating the Affordable Care Act’s effectiveness. But it does mean that conservative opponents may be running out of credible reasons — if ever there were — to call Obamacare the worst thing to hit America since slavery.

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