The Department of Health and Human Services is being urged to add another qualifying event to the list of ways people can buy an exchange plan in a "special enrollment period."
Some 30 national health groups including Planned Parenthood, are joining 50 House Democrats and 37 Senators in calling on Health and Human Services Secretary Sylvia Mathews Burwell to issue guidance classifying pregnancy as a "qualifying life event," to let uninsured women who become pregnant purchase a health plan through Healthcare.gov within 60 days.
"If a woman becomes pregnant while uninsured at a time outside of the annual open enrollment period, or is enrolled in a grandfathered plan that does not cover maternity services, she will not be able to access coverage for maternity care," the House Democrats wrote.
"These women are forced to either forgo critical prenatal care or face significant out-of-pocket costs. Special enrollment periods currently exist for qualifying life events like the birth of a child or the adoption of a child. We believe pregnancy should trigger a similar special enrollment period."
The addition of pregnancy would add to a list of qualifying life events that includes moving to a new state, drastic changes in income, marriage, divorce and the birth of a baby and adoption. And it seems that HHS has the authority to add pregnancy, as the agency wrote in a recent regulatory summary, although there were no plans to do so. Advocates are also calling on state exchanges, such as Covered California, to adopt a similar policy.
With pregnancy and a non-complicated childbirth costing in range of $10,000, some insurers might be leery about potential unintended consequences from adding pregnancy to the list of qualifying events--if it might leave some women likely to only buy insurance once they need it.
"If you only create incentives for people to enroll when they have a health need, it poses a tremendous risk to the risk pool and affordability for everyone else," as Clare Krusing, communications director at America's Health Insurance Plans, told National Public Radio.