A petition to make pregnancy a qualifying event in Colorado – but something doesn’t add up

Last month, Broomfield resident Sean Jenks created a Change.org petition asking Colorado lawmakers to allow a special enrollment period for women who become pregnant.  It’s picked up considerably steam in the last 24 hours, and now has more than 13,000 supporters.

Jenks points out that New York and California have taken steps to make pregnancy a qualifying event in those states (the bill passed in NY but hasn’t been signed by the governor yet, and the legislation in California is still under consideration but has considerable support).  There are pros and cons either way, and the issue tends to be somewhat controversial.  HHS clarified earlier this year that they reviewed the issue and opted not to make pregnancy a qualifying event.  But states are free to establish their own requirements that go above and beyond those laid out by HHS.

Many patient advocates have been pushing to make maternity a qualifying event, and their efforts are gaining momentum in several states.  I am a bit perplexed however, by Jenks’ story that accompanies the petition.  He notes that his wife has health insurance, but that it was purchased before the ACA was signed into law, and so the maternity benefits required by the ACA don’t apply to her coverage.  He says they thought they were covered, but they found out recently that his wife’s coverage doesn’t include maternity benefits.

That would make sense if they lived in another state.  It’s true that grandfathered plans (those purchased prior to March 23, 2010) in the individual market do not have to provide maternity benefits under the ACA.  But Colorado tackled that problem five years ago, when House Bill 1021 was signed into law by then-Governor Bill Ritter.  The law required all health insurance plans in Colorado – including the individual market – to include maternity coverage.  It took effect January 1, 2011 for new policies, and applied to policy renewals as of the first renewal on or after January 1, 2011.  So by December 31, 2011, every policy in Colorado included maternity benefits.

The law didn’t apply to “supplemental policies covering a specified disease or other limited benefit” (text of the law is here) but Jenks petition doesn’t indicate that his wife is covered by nothing but a specific illness policy (eg, a cancer-only policy) or limited benefit plan (more on limited benefit plans here).

So I’m perplexed as to how Jenks’ wife has a Colorado-based health insurance plan that has renewed at least four times since January 1, 2011, and yet it still doesn’t have maternity benefits?  In Colorado, even plans that are considered grandfathered under the ACA are still required to include maternity benefits, and that’s been the case for several years.  Colorado’s law has nothing to do with the ACA – the state implemented it independently of the ACA.

In summary, something doesn’t add up.

On another note, I also want to use this as an opportunity to point out that maintaining quality health insurance coverage needs to be a priority year in and year out.  Jenks notes that “Pregnancies are often unplanned, making limited enrollment periods impractical for many women.”  But can’t that be said of any medical condition?  In fact, I would say pregnancy is one aspect of healthcare that’s probably much more likely to actually be planned.  While about half of pregnancies are planned, I doubt the same could be said for cancers, heart attacks, or car accidents.

If you’ve been putting off getting health insurance because you “don’t need it” remember that not needing it today doesn’t mean you won’t need it tomorrow.  Thanks to the ACA, pre-existing conditions are no longer a obstacle to obtaining coverage, and subsidies (both premium subsidies and cost-sharing subsidies) make coverage affordable for people who couldn’t afford it in the past.  But open enrollment periods are a necessary part of a system that allows anyone – regardless of health conditions – to enroll in any plan they wish.  Those limited enrollment periods will certainly be an obstacle if you find yourself uninsured and in need of medical care in the middle of the year.

About Louise Norris

Louise Norris has been writing about health insurance and healthcare reform since 2006. In addition to the Colorado Health Insurance Insider, she also writes for healthinsurance.org, medicareresources.org, Verywell, Spark by ADP, and Boost by ADP, and Gusto. Follow on twitter and facebook.

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