In mid 2010, Colin Wambsgans needed to find new health insurance. The small software company he worked for was sold to a larger company, and because he was a part-time employee, he didn’t qualify for the new company’s insurance plan. Getting coverage was especially urgent because his wife was pregnant.
But at that time, the newly passed Affordable Care Act hadn’t yet gone into effect. So Wambsgans, now 39, still had to navigate the old marketplace, where pregnancy ― or even planning to get pregnant ― was considered a pre-existing condition.
The only way they could get insurance, they were told, was if they were no longer pregnant ― and that included if they decided to get an abortion.
“I didn’t ask them [the insurance company] to cover an abortion, but they did say that if she wasn’t pregnant, then you would get covered,” said Wambsgans, who lives in Los Angeles. “I said, ‘Well, if she has an abortion, we can get coverage?’ And they said yes.”
Wambsgans and his wife had been trying to get pregnant, so they didn’t want to terminate the pregnancy. But they also hadn’t realized how hard it would be to get the important prenatal care that they needed.
“We even talked to friends who were health care professionals afterward who didn’t understand that pregnancy was a pre-existing condition,” he told The Huffington Post. “It was just this strange hidden thing. I don’t know how much it would’ve impacted our decision to have a child. But also, I didn’t know my company was going to be sold when it got sold. The timing of it wasn’t really under our control.”
Before President Barack Obama signed the Affordable Care Act in 2010, insurance companies were allowed to automatically turn down people for coverage if they were pregnant or even thinking about getting pregnant ― except in a handful of states that outlawed the practice. This restriction applied to men whose wives were pregnant or trying to be pregnant as well.
Insurance companies would even look at doctors’ records to determine if the applicants might soon be expectant parents.
“If you were working on getting pregnant and talking to your doctor about it ― working on getting ready, stopping your birth control, all that other kind of stuff, and that was documented in your medical records ― that was it. You were out,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
As Republicans talk about repealing Obamacare as soon as Donald Trump becomes president, there’s increasing worry among beneficiaries about what they could lose if the law goes away.
Some Republican lawmakers have faced stronger-than-expected opposition from their constituents to getting rid of Obamacare. Rep. Mike Coffman (R-Colo.), who represents a swing district in the Denver suburbs, recently had more than 150 people show up to his town hall meeting ― with most of them pleading with him not to repeal the health care law without a suitable replacement ready.
Dozens of people showed up to Rep. Kevin Brady’s (R-Texas) little-advertised town hall meeting Tuesday also expressing their displeasure at a possible repeal.
More and more Republicans are also getting skittish about quickly repealing the health care law without a replacement ready to go. But that remains complicated, since everyone seems to want to keep the popular provisions ― such as making sure pregnancy isn’t a pre-existing condition ― without figuring out how to pay for them. The reason provisions like the individual mandate were part of the Affordable Care Act was so that insurance companies would get a pool of healthy people to sign up to offset some of the costs of people with more expensive conditions.
A 2013 report by Truven Health Analytics found that the average total charges for pregnancy and newborn care are $32,093 for vaginal births and $51,125 for cesarean births without insurance. Commercial insurers typically pay an average of $18,329 and $27,866 of those amounts, respectively.
The Congressional Budget Office recently concluded that 18 million people would lose their insurance and people’s premiums would skyrocket if Republicans go ahead with their repeal. The office looked at GOP legislation that would have eliminated the individual mandate and its tax penalties while still preserving the requirement for insurers to provide coverage without denying pre-existing medical conditions.
“Eliminating the mandate penalties and the subsidies while retaining the market reforms would destabilize the nongroup market, and the effect would worsen over time,” the CBO said.
The Kaiser Family Foundation estimates that 27 percent of adults in America under the age of 65 have conditions that likely would have made them ineligible for private health coverage if they had applied under the pre-Obamacare rules. Those pre-existing conditions include sleep apnea, obesity and HIV/AIDS.
Wambsgans and his wife were able to eventually get coverage in 2010. But it was incredibly complicated. They found someone who specialized in getting artists health care, and through a provision in California law, they were able to register as a small business and get coverage that way.
“It felt pretty much like luck that we had got in touch with this guy who could help us out. That’s not an intuitive solution to the problem,” he said.
“You should be able to have a child when you want to have a child,” he added. “The ACA covers contraception and that made it free and a lot easier. But also just, if you’re pregnant you can’t get health insurance, you can’t get prenatal care in an easy way. ... There are just so many important provisions that matter so much for women’s health, so that means they matter for everyone, for society. If it’s repealed, it’ll be pretty bad.”
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