Insurers: Full pregnancy coverage would raise premiums

"This bill removes barriers from the continuum of pregnancy-related medical care, ensuring that all medical care related to pregnancy be provided free of all deductibles, copays and cost sharing," said Sen. Cindy Friedman, D-Arlington, the bill's sponsor. "We did this for MassHealth (the state program that covers Medicaid and the Children's Health Insurance Program), I'm asking we do this for all commercial payers to ensure that people get needed care at important times in the developmental cycles."

The bill, as it is written, does not dictate what is or is not covered by insurance policies; it just states that there be no cost-sharing of any kind for the services. It would include all private, fully-funded insurance plans and insurance provided through the state for state and municipal employees. It is already a benefit for residents insured through MassHealth.

During the last legislative session, state lawmakers made sure that abortion and abortion care services were fully covered by health insurers and abolished the practice of meeting deductibles, charging copays or otherwise requesting patients foot part of the bill.

That law was a reaction to the overturning of Roe v. Wade by the U.S. Supreme Court in 2022.

Does the bill change what's covered?

"In the last session, with the repeal of Roe, the Senate came to have a greater awareness of how best to support pregnant people and the need for maternal health care," said Sen. Jamie Eldridge, D-Marlborough, one of the co-sponsors of the bill. "It's not just a question of reproductive rights, but a recognition that the health care system is private, for-profit. The costs for pregnancy is borne by families and is a burden on the state's poorer residents and people of color."

"I'm proud to co-sponsor this bill, which puts the health of pregnant people first," said Sen. Rebecca Rausch, D-Needham, in a prepared statement. "There should never be a question, hesitation, or concern about accessing maternal health care, and yet that is the circumstance for too many people for whom that routine and necessary care is financially out of reach. Whether the decision is to start a family, grow a family, or end a pregnancy, pregnancy care must be affordable and accessible to all Bay Staters."

Supporters said financial considerations prompt many Massachusetts residents to opt for insurance coverage that has lower monthly premium costs and higher deductibles, meaning patients have to pay a certain amount for covered services out-of-pocket before the insurance kicks in.

"More than 1.7 million Massachusetts residents have opted for a low-cost/high deductible health care plan," said Claire Teylouni, of Reproductive Equity Now, at a hearing on the bill held in May. The number of residents opting for those low-cost plans has risen from 14% to 43% of people paying for private, commercial market insurers since 2013.

Those high-deductible thresholds and copays serve to discourage pregnant people from seeking necessary pregnancy-related medical care, or any medical care, Friedman said, adding that the lack of services could have serious health consequences for the mothers and their children.

In her testimony, the senator quoted a Center for Health Information and Analysis review of the proposal that predicted a miniscule increase of premiums across the board to lie between 0.23% and 0.32%. "It's looking like a very small impact to the cost of the premiums," Friedman said.

Concerns from Massachusetts health plan providers

However, the Massachusetts Association of Health Plans president and CEO Lora Pellegrini said the organization and its members are "deeply concerned about efforts to eliminate consumer cost-sharing whether for a particular drug or a broad range of services."

The organization anticipates increased premiums for covered individuals in the state. Without the ability to share costs with patients, Pellegrini predicted a $237 million increase in premium costs over five years.

"If cost-sharing is eliminated for one service, the actuarial value of the insurance product changes, increasing the overall premium," Pellegrini said in a prepared statement. She said members work "diligently" to keep premiums and cost-sharing as low as possible.

"In the case of pregnancy and childbirth, health plans provide coverage for routine prenatal care including office visits without cost-sharing, as well as preventive services as outlined in federal guidance including no-cost depression and anxiety screenings and interventions, gestational diabetes screenings and healthy weight counseling, screenings for hypertension and sexually transmitted infections, and breastfeeding interventions for postpartum women," Pellegrini said.

Barriers to accessing health care for low-income households

Statistically, lower-income households pay more of their total incomes for health care costs, including insurance premiums, than higher-income households, according to Freedman Healthcare in a report released in 2017 that provided a view of price variations between insurance providers.

A Massachusetts family of three with a $60,000 household income paid 30% of that for health care costs; the percentage of income dedicated to health care decreased as earnings increased: Households with an income of $120,000 spent 18% of it on health care costs, according to the report.

Cost-sharing demands, coupled with a low income, can be a prohibitive obstacle to accessing pregnancy care.

"Women should not face the choice of going into debt for basic reproductive services or putting food on the table," said Judith Hirschfield-Bartek, of Falmouth who spoke in favor of the bill in May. "Health care is a right for all women, not a privilege reserved only for those who can afford it."

Jan Soma, with the Massachusetts Chapter of the League of Women Voters, pointed out that 97% of women in Massachusetts are covered by health insurance, yet many still have challenges affording reproductive health care.

"Lower income women are least able to afford the extra costs," Soma said, adding that, on average, Massachusetts women pay about $4,500 for pregnancy care; funds that could better be dedicated to the cost of rearing the child rather than birthing it.

Costs soar with complications; as visits increase, so do co-pays

One woman, Katie Ford, spoke of the financial burden she faced when she became pregnant with Mono-di twins, (Monochorionic diamniotic). The fetuses share a placenta, but each has their own amniotic sac, a rare pregnancy that enhances the potential for complications.

Weekly visits for scans were the norm, each requiring a co-pay and out-of-pocket costs that were random, inconsistent and "always high." Changes in insurance, including a renewal, meant that she failed to meet her deductible while she was pregnant and then had the deductible reapplied on the policy renewal.

"It was the same pregnancy," Ford said.

Throughout her pregnancy, Ford said, rather than focus on her condition and the coming leap into parenthood, she fretted about whether costs incurred were covered by insurance.

"It took us three years to pay off the cost of maternity care," Ford said. "Families should not have to risk bankruptcy to have a child."