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California Individual Health Insurance Market Troubling for Mothers-To-Be

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(Sacramento, CA)
Friday, September 30, 2011

In her late 20s, Wendy Askew and her husband Dominic had dreams of parenthood, and ideals for how to get there.

ASKEW: "We made really specific plans around our career choices so that we would have flexibility, so that when we started a family we would be able to be home and raise our own children."

They were each self-employed in professions to accommodate that. Wendy started her own business as a frozen fruit broker. Dominic is an architect.

ASKEW: "So we had an individual insurance plans, and we had high deductibles. So we had money set aside. We were trying to be responsible and make plans in advance."

But when Wendy started looking for a gynecologist in Monterey County in 2006, she found there were none available under her health plan.

When she tried to find a new policy, she says only two of around 100 available policies covered maternity.

The policies had a $500 premium, with a deductible of up to 10,000 dollars.

ASKEW: "We were starting to feel like that was something outside what we had planned for."

Research shows maternity coverage in some individual insurance policies has been eroding dramatically in recent years.

Seven years ago, over 80% of policyholders on this market had maternity. Now, only 12% have it.  

MCGOVERN: "To provide basic health care for men, and not provide basic health care for women, in policies that don't cover maternity, that is gender discrimination."

Beth McGovern is with the California Commission on the Status of Women.

She says women trying to buy maternity coverage on this market face high costs.

The number of available maternity policies and the costs associated with them vary according to where you live in California.

But an independent study estimates California women enrolled in policies without maternity could be paying almost $122 million in out of pocket pregnancy costs.

McGovern says the trend also compromises care.

MCGOVERN: "If a women are…find themselves pregnant and don't have maternity coverage, the likelihood is that they will eventually find a state program. One of the downsides of that, in addition to costing the state money is that usually means a delay in prenatal care."

McGovern says what's needed is a mandate requiring maternity coverage in all California health policies.

MCGOVERN: "…So that those costs and the risks are spread among everyone."

But Richard Wiebe of the Association of California Life and Health Insurance Companies says insurers want flexibility so individuals can buy just the coverage they need.

He says maternity coverage has been on the decline because there's a demand for cheaper policies.

WIEBE:  "A middle-aged man such as myself looking for individual health coverage would prefer to save a few dollars, and not buy a policy that includes maternity coverage. By the same token, a 25 year-old woman would probably prefer to buy a policy which wouldn't include prostate cancer.

Anthony Wright of Health Access says segmenting risk in health insurance raises a larger issue. If one insurer stops offering a benefit such as maternity, others follow suit to stay competitive.

WRIGHT:  "This is why we need a minimum threshold of what coverage is defined as."

Essential benefits, including maternity, are part of federal health reform slated for 2014.

Wright says these California mandate bills pave the way.

WRIGHT: "The whole point of health reform is to move away from a marketplace where insurers compete based on how deftly they can collect premiums from healthy people while avoiding sick people, and we can move toward a marketplace where they actually compete on things like cost and quality and customer service.

A study of an earlier version of the maternity mandate bill says a new law could result in up to 10,000 newly uninsured people.

In the meantime, Wendy Askew in Monterrey left her fruit business and now works a 9-5 job.

ASKEW: "And we're currently pregnant, six months pregnant with our first child and my maternity care has been paid for from my large group employer."

The irony is, says Askew, she no longer has a job where she can raise her child while working at home.

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