June 4, 2015
S.5548A (Hannon) / A.7836 (Simotas) and S.4639A (Krueger) / A.6780A (Simotas)
Health care during pregnancy is critical to reducing health care costs and improving health outcomes for women and children. Under current law, if an uninsured woman becomes pregnant, she cannot enroll in a health plan unless and until the plan's "open enrollment" period commences, or when she has her child. Without health insurance, it is difficult for women to access critical prenatal care.
Three pending bills would address this barrier to care: S.5548A/A.7836 would amend New York's public health law to allow pregnant women to enroll in a plan on the state's health exchange outside of the "open enrollment period;" S.4638A/A.6780A would accomplish the same goal by amending the insurance law; and S.5686 would incorporate this amendment in insurance plans on the open market as well. The NYCLU strongly supports legislation that would allow uninsured women who become pregnant to receive health insurance without delay so that they can begin accessing care.
Regarding Support for S.5548A (Hannon)/A.7836 (Simotas) and S.4639A (Krueger)/A.6780A (Simotas)
Pregnancy-related health care, including prenatal care, is critical to reducing poor pregnancy outcomes. However, nearly one-third of women giving birth in New York fail to receive prenatal care early in their pregnancies.1 Women who do not receive prenatal care are three times more likely to give birth to a baby with low birth weight.2 And these babies have an infant mortality rate five times that of babies whose mother received recommended care in the first trimester of pregnancy.3
In addition, these disparities are much higher for communities that historically experience difficulty accessing the health care system, including poor women and women of color.4 To reduce infant mortality rates and improve healthy birth outcomes, New York must reduce barriers to pregnancy-related care, including lack of insurance coverage.
Currently, individuals and businesses may sign up for health insurance coverage during "open enrollment" periods designated throughout the year. This is true for insurance plans available to New Yorkers through the New York State of Health Marketplace created pursuant to the federal Affordable Care Act (ACA), and to insurance plans available on the open market.
Under the ACA and most non-marketplace insurance plans, certain qualifying life events – such as getting married, divorced, gaining citizenship, being released from prison, moving to the state, or having a child – allow people to enroll in a health care plan outside of this open enrollment period. These plans provide a "special enrollment period" for individuals who experience a qualifying life event.
While actually having a child is a qualifying life event, pregnancy is not. This means that women who become pregnant and do not have health insurance are faced with the choice of foregoing insurance coverage or paying out of pocket, if they can afford to do so at all. Indeed, the costs associated with prenatal care and delivery average more than $20,000, even for uncomplicated births.5 Each of the above-referenced bills would add pregnancy to the list of qualifying life events that allow women to receive insurance during a "special enrollment period".
Under this provision a woman can immediately sign up for health care coverage regardless of whether her pregnancy commences during a designated enrollment period under current law. This will not only allow women to get the pregnancy-related care that they need, it also generates cost savings over the long term. Studies show that by improving infant health outcomes by providing prenatal care reduces costs substantially.6
Regarding Qualified Support for S.5686 (Seward)
While we support all three bills, we are concerned about the provision in S.5686 that requires the applicant to obtain certification of pregnancy by a health care provider in order to be eligible for insurance coverage enrollment. In order to certify a pregnancy under S.5686, an applicant would need to pay out of pocket costs to see a health care provider, thus potentially deterring the applicant from getting the pregnancy-related care she needs and ultimately frustrating the intended purpose of the legislation. For this reason, the NYCLU urges the sponsor to remove this provision from the bill.
Given the established link between prenatal care and improved health outcomes for women and children, and the New York State Department of Health's stated goal of reducing infant mortality in New York, it is in the state's interest to remove barriers to accessing insurance. The NYCLU urges lawmakers to pass legislation allowing pregnant women to enroll in a health plan in order to access care at any time, regardless of when they become pregnant.
1 New York State Department of Health, Birth Outcomes: Promoting Healthy Birth Outcomes (2015), available at http://www.health.ny.gov/prevention/prevention_agenda/healthy_mothers/bi....
2 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health, Prenatal Services (2015), available at http://mchb.hrsa.gov/programs/womeninfants/prenatal.html.
3 U.S. Department of Health and Human Services, Health Resources and Services Administration, Prenatal - First Trimester Care Access (2015), available at http://www.hrsa.gov/quality/toolbox/measures/prenatalfirsttrimester/part....
4 See Birth Outcomes: Promoting Healthy Birth Outcomes, supra note 1 (For example, in 2008, 12.5% of black infants were born low birthweight, and black women were more likely to have preterm births than white and Hispanic women).
5 U.S. Department of Health and Human Services, The Affordable Care Act and Maternity Care (2015), available at http://www.hhs.gov/healthcare/facts/factsheets/2015/05/affordable-care-a....
6 James Henderson, The cost effectiveness of prenatal care, Health Care Financ Rev. 15, no. 4 (1994): 21-32 (associating prenatal care and birth outcomes and the implications for hospital costs for newborn infants. The net expected hospital cost savings for females who received prenatal care was over $1,000.); Richard Behrman and Adrienne Butler, Institute of Medicine (US), Committee on Understanding Premature Birth and Assuring Healthy Outcomes, Preterm Birth: Causes, Consequences, and Prevention, National Academies Press (2007) (the annual societal economic burden associated with preterm birth in the United States was, at a minimum, $26.2 billion in 2005, or $51,600 per infant born preterm).