By Alicia Adamczyk
March 23, 2017

The cost of having a baby could skyrocket if House Republicans make a reported change to their health care bill.

In order to win over hard-line conservatives, Republicans are considering stripping the so-called “essential health benefits” provision from the American Health Care Act, according to Politico. Under the Affordable Care Act, 10 categories of care—including coverage of maternity and newborn care—had to be covered under individual, marketplace, and small business insurance plans. But if that requirement is eliminated, insurers could once again sell plans that don’t cover pregnancy-related costs.

Republican lawmakers have singled out maternity care in particular as problematic, saying men shouldn’t have to pay for these services, and that women should have to pay more if they want the care—as they did before the passage of the ACA. The GOP-backed health care overhaul would let people would pick and choose the exact coverage they need.

“It’s a back-door form of discrimination,” says Debra Ness, president of the National Partnership for Women and Families. “If you take away the requirement around what the plans have to cover, and women can’t get the same plans as men at an affordable price, then you really can’t say it’s not discriminatory.”

Should they lose guaranteed maternity coverage, women of child-bearing age could face huge costs. According to estimates from Milliman, a health care consulting firm, premiums for those under 40 could be 25% to 70% more expensive if they want maternity coverage, compared to plans without.

And without coverage, maternity bills could be overwhelming. The average total cost of pregnancy and newborn care varies widely, but was about $30,000 for a vaginal delivery and $50,000 for a C-section in 2010, a report commissioned by three health groups found. The national average out-of-pocket cost to give birth for those with insurance is around $3,400.

According to a report from the National Women’s Law Center, just 12% of individual market plans included maternity coverage before the ACA was passed. Women who wanted maternity coverage in the past could purchase a rider with an additional monthly premium, in some cases—but “this supplemental coverage [was] often expensive or limited in scope,” the NWLC notes. Some riders had deductibles as high as $10,000, and waiting periods as long as a year before the coverage could be accessed, the organization found.

There are other motherhood-related costs that fall under the umbrella of “essential health benefits.” Covered items include prenatal visits, preventive prenatal services, breast pump rentals, and support services for women with postpartum depression. Those increased costs leave some financially strapped women and babies without the care they need.

Notably, no one knows yet if essential health benefits are actually going to be cut from the GOP bill—because the Republicans have not made the changes from their original draft public. That makes it impossible to gauge the results of the new legislation that impacts one-sixth of the economy.

Preventive care is also one of the essential health benefits, and has led to co-pay-free birth control for millions of women. So not only would having a baby become more expensive, but not having a baby would as well.

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