[Note: This is a mildly edited speech I gave this morning.]
Imagine yourself, you or your mate has just had a baby, the little life wiggling in your arms screaming at the top of your lungs. You feel fortunate that this child is healthy and happy. In the back of your mind, that part you don’t let speak, you think, “It’s only 15 grand. Whew!”
The average cost to have a baby in the U.S. is $10-25k. But if there are complications, you could conceivably be in the hundreds of thousands and even millions of dollars. This is financial ruinous without some form of insurance. Sadly, there is a portion of the women in this country that cannot get an insurance policy with maternity coverage.
You might be surprised to know that federal law does not directly require anyone to provide maternity coverage. However, most “group plans”, the ones covered by employers, include it because of the Pregnancy Discrimination Act of 1978, an amendment to Title VII of the Civil Rights Act. This act prohibits discrimination based on gender, pregnancy, childbirth, or pregnancy-related conditions. It requires health plans sponsored by employers with 15 or more employees to cover pregnancy, childbirth, and pregnancy-related conditions in the same way as other “temporarily disabling conditions”. There are other laws that, when mixed with this, effectively require any large employer to offer maternity coverage.
State laws are quite varied. 18 have state mandates that require coverage of maternity care. Of those, only 12 mandate it for the individual market. 17 require it in the small group market. Some require both. I’ll tell you about California laws in a minute, but let me give you another number.
15
15 states require infertility coverage. Of those, 7 require infertility but not maternity coverage. Arkansas, Maryland, New Mexico, Ohio, Rhode Island, Texas, West Virginia have some requirement to help you get knocked up but offer no help afterwards.
In California, there is a law that requires HMOs to provide maternity coverage — but not PPOs. Representative De La Torre of Las Angeles had proposed to fix that by forcing PPOs to provide coverage. He proposed it for 4 years strait (2006 through 2010) and it even passed the legislature. However, Gov.Schwarzenegger vetoed it every time. The last time, in 2010, he said this: “While I acknowledge the author’s effort to address the reason for the last three vetoes on similar measures, the bill continues to represent a significant barrier to affordable coverage”
This year, State Senator Noreen Evans will introduce it again.
In Texas, which is in many ways my home state, there are no laws requiring maternity coverage (but, remember, they do require infertility coverage). And guess what, as of May 2010, there are *no* companies offering maternity coverage for individuals. That’s right. You must be employed by a major employer to get maternity coverage or take the risk that you can afford the birth and any potential complications. If you are an individual either out of work or self-employed, you cannot buy that coverage.
My wife and I had recently decided to move back to Texas. Well, we decided that we wanted another child. As we prepared our move to Texas, we discussed the need for insurance since my wife was going to resign to move. Imagine our surprise to discover that there is no way for us to get that insurance. It’s even more sad that the insurance agent I discussed this with, a woman, said that she and her husband have put off having children because she and he are both self-employed and cannot get coverage.
The National Organization of Women have characterized this as a women’s rights issue. I think that’s true, but it also affects fathers as well.
If you think this is an issue that needs to be addressed, please write to your congressperson. In Texas, we have to start at zero. If you write, you might want to mention the infertility versus maternity issue. If you live in California, you can write to support Noreen Evans’ bill to address the issue. Who knows, maybe Gov. Brown will actually sign it. Future expectant mothers and their mates will thank you.
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