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In California, many women who are planning families pay higher premiums with larger deductibles to secure optional maternity coverage.
At the same time, thousands of other women are guaranteed maternity benefits at no extra charge.
The disparity lies in state law, but attempts to change it are entangled in broader questions, from affordable premiums for individuals to the long-term societal costs of not providing prenatal care.
State law does not require insurers to include maternity services as part of individual health care policies. Policyholders who want that option, which is increasingly harder to find as health care costs soar, are routinely charged more.
But separate state regulations dictate that large, mostly employer-provided group health plans include prenatal and delivery services as part of the basic package of covered care.
Gov. Arnold Schwarzenegger has stymied previous attempts to change the law, twice vetoing measures that would require all insurers to include maternity services at no extra charge.
“A mandate, no matter how small, will only serve to increase the overall cost of health care,” the Republican governor said in his veto message last year.
Undeterred, Assemblyman Hector De La Torre, D-South Gate, has reintroduced legislation, which could cover more than 6,000 pregnancies a year.
“Women and their families should not have to struggle for fair treatment in their health care,” De La Torre said.
Wendy Askew was one of those struggling. When she and her husband began planning a family, Askew figured they were doing everything right as they shopped for an individual health insurance plan that included maternity benefits. Both were self-employed at the time.
“I thought: How much could a pregnancy cost?” said Askew, who lives on the Monterey Peninsula.
The labyrinth of policies she explored all had a similar answer: soaring premiums and higher deductible.
“I would be paying three to five times more money just because I’m a woman who needs maternity coverage,” Askew said.
Frustrated, Askew has become active in attempting to change the system, lobbying lawmakers.
“As a community, if we don’t value families we have even bigger problems,” Askew said. “We need to value families, and we need to value women.”
Representatives of insurers that write individual plans warn that such a change in the law would trigger higher premiums that could push large numbers of Californians into the ranks of the uninsured.
“The more folks covered, even if it’s not a Cadillac, is better than folks being uncovered,” said Steven Lindsay, who represents the California Association of Health Underwriters that serves the individual insurance market.
Lindsay said cost-conscious consumers demand some a la carte pricing, which allows them to pick and choose types of coverage based on personal needs and paychecks.
Lawmakers who insist on all-inclusive policies “want to force all insurance products to be alike,” Lindsay said. “What we’ve seen from the buying public is they want choice.”
But supporters say adding maternity coverage would not be that much more expensive – $7.60 a month – because a larger pool of Californians with vastly different health needs would dilute risk and spread costs.
“What you want to do is blend coverage so it doesn’t hurt any one person at any one time in their lives,” said Tom Riley, representing the California Academy of Family Physicians.
More than 1 million Californians in mostly work-provided group plans are covered for pregnancies. In contrast, just 211,000 are covered by individual plans, according to estimates developed by the California Health Benefits Review Program, an arm of the University of California.
Uninsured women spend about $67.8 million out-of-pocket annually for noncovered care. By requiring maternity care, coverage could be extended to 147,000 women between the ages of 19 and 44, the university reported. The average uncomplicated pregnancy costs $11,100, the UC health review program estimates.
Just as importantly, supporters of the measure say, is that the legislation would save the state and taxpayers money. Currently, according to state reports, many women without maternity care turn to state assistance, such as Medi-Cal or Access for Infants and Mothers.
Every year about 2,700 women enrolled in individual health care insurance plans switch to state-provided programs, according to the University of California.
The March of Dimes has been a leading advocate for the legislation, arguing that uninsured women tend to seek out less prenatal care because of costs, leading to a higher risk of premature births and accompanying health problems for them and their children.
During the debate last year, Gail Margolis, representing the March of Dimes, said the requirement “will save both lives and money.”