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What to expect when you’re expecting? Under Obamacare, no special open enrollment for a woman who’s “with child,” but without healthcare coverage.
Although the Affordable Care Act (ACA) has expanded coverage for women’s health services, including mandating maternity coverage as an essential health benefit in marketplace plans, The Department of Health and Human Services (HHS) has denied a request from Democrats to create a special open enrollment period for newly pregnant women who lack health insurance.
In an April 10 reply to the March letter sent by Senate Health, Education, Labor and Pensions (HELP) Committee ranking member Sen. Patty Murray (D-Wash.) with 36 signatures, HHS Secretary Sylvia Mathews Burwell said the agency does not have “the legal authority to establish pregnancy as an exceptional circumstance” to create a special enrollment period.
In her written response, Burwell stated that pregnant women with low and moderate incomes could enroll “at any time if they qualify” in Medicaid and the Children’s Health Insurance Program (CHIP). “And, like all other qualified individuals, pregnant women can enroll in the Marketplace during the annual open enrollment period,” she added.
Originally, lawmakers requested the special enrollment period to address a coverage gap that could leave women without accessible maternity care. They said that without this health insurance, women would either do without prenatal care, which could increase the risk of acute medical complications like preeclampsia or placental abruption, or face high out-of-pocket costs.
In a statement to NPR in February, Burwell said HHS had not included pregnancy as a qualifying life event because it was following standards set by insurance companies in determining open enrollment periods. She added that HHS was open to considering the issue.
“The administration has the authority to create special enrollment periods in cases like these, but is instead ignoring the calls to protect women's health of nearly 100 members of Congress, over 100,000 consumers, and dozens of organizations to do so,” said Jen Mishory, executive director of the millennial advocacy group Young Invincibles, in response to the decision. “The administration has named many extraordinary circumstances qualifying life events for special enrollment, and there's no reason — legal or otherwise — they cannot do so here.”
The Obama administration’s special enrollment period allows sign-up through April 30.