Since the Department of Health and Human Services has declared May 12 the start of National Women's Health Week, here’s an idea for the perfect Mother’s Day gift: Timely and affordable prenatal care for any current or future mother-to-be. Early access to prenatal care helps identify health risks during pregnancy, and assists health providers in addressing and managing health conditions that may harm the mother and infant. Prenatal services include screenings for high blood pressure, HIV, depression, chronic health conditions, and fetal heart tones; immunizations for tetanus and rubella; and counseling education interventions.
Prenatal care is essential for any pregnant woman, and is particularly critical for low-income women and women of color, who are more likely to experience health risk factors that could lead to pregnancy-related complications. Compared to higher income pregnant women, pregnant low-income women are more likely to smoke, have three or more chronic health conditions, and be uninsured before pregnancy. Women of color are at particular risk for developing gestational diabetes. According to the CDC, the rate of pregnancy-related deaths from 2006 – 08 was 34.8 deaths per 100,000 for black women, compared to 14.5 for women of other races, and 11.3 for white women. And, blacks and Hispanics experience greater rates of preterm births — the leading cause of infant mortality — than whites in most states.
Health providers and advocates emphasize the importance of prenatal care in avoiding and treating health conditions that create adverse pregnancy outcomes. However, prior to the Affordable Care Act (ACA), health plans routinely excluded maternity care, or treated pregnancy as a pre-existing condition. Starting January 1, 2014, the ACA requires maternity care as part of the Essential Health Benefits.
The ACA also takes a giant step forward by requiring that most new health plans – in and out of the Insurance Exchanges, and even including self-insured plans – cover prenatal care without cost-sharing. The ACA requires that these plans cover a range of preventive services including all U.S. Preventive Services Task Force (USPSTF) A&B Recommendations. In addition, Health Resources and Services Administration (HRSA) commissioned the Institute of Medicine (IOM) to produce evidence-based recommendations for specific women’s health preventive services to be covered. The IOM report, Clinical Preventive Services for Women - Closing the Gaps, recommended eight services including screening and/or counseling for gestational diabetes, HIV, sexually transmitted infections (STIs), human papillomavirus (HPV), and interpersonal and domestic violence; all FDA-approved contraceptive methods, as well as counseling; and well-woman visit(s). HRSA adopted the recommendations, and as of August 1, 2012, most plans must cover these eight services without cost-sharing.
Well-woman visits include prenatal care, as well as preconception and interconception care. Well-woman visits can be as frequent as a medical provider determines is necessary. The recommendations are clear that women with high-risk pregnancies may need more visits, all without cost-sharing.
Coverage of prenatal care in well-woman visits without cost-sharing requirements addresses financial barriers to needed maternity services. For future Moms-to-be, this is one Mother’s Day gift that will certainly be appreciated.
This blog post was developed by Susan Berke Fogel, J.D., Reproductive Health Director and Deborah Reid, J.D., Senior Attorney at the National Health Law Program (NHeLP).
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this blog do not represent those of the Robert Wood Johnson Foundation.