The Patient Protection and Affordable Care Act (also known as Affordable Care Act, ACA, and “Obamacare”), enacted in 2013, is designed to make medical coverage for all Americans easier to pay for and easier to access than ever before. Various elements of the act have been implemented already but the phased rollout won’t be complete for a few more years. In the meantime, Americans have many questions, including how the act affects pregnancy, childbirth, and newborn coverage.

The Newborns’ and Mothers’ Health Protection Act Of 1996 (Newborns’ Act)

The ACA builds on the protections to women and children that were mandated in 1996 by this law. The Newborns’ Act protects parents and their newborns from irregularities or omissions of coverage from individual state mandates and by medical care insurance providers. The act requires:

• A 48-hour minimum hospital stay for vaginal deliveries
• A 96-hour minimum stay for cesarean section deliveries
• Early release is possible but doctor and patient must agree
• No preauthorization of hospitalization is required although some plans may require notification of pregnancy or impending childbirth

The Health Insurance Portability and Accountability Act (HIPAA)

Employers are usually restricted to enrolling in company health plans when they are hired and for a limited period (open season) each year. This act requires a special enrollment provision that allows employees to enroll themselves and their families at any time during the year when certain conditions apply. Special enrollment is allowed within 30 days of:

• Birth of a child
• Adoption of a child
• Placing a child for adoption

Pre-existing conditions must be the same during special enrollment as they are during other enrollment periods.

The National Partnership for Women & Families

This nonpartisan, nonprofit advocacy group promotes fairness in the workplace, access to quality health care for all, and employer policies that make it easier for men and women to meet the demands of work and family. The ACA allows each state to establish a benchmark of coverage and the partnership works with state governments to ensure these benchmarks adequately meet the needs of women, men, and their families.

The Patient Protection and Affordable Care Act

Maternity care has often been excluded from coverage but it is on the ACA list of ten services that all private health insurance must cover:

• Ambulatory (outpatient) patient services
• Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Mental health and substance use services
• Pediatric services
• Prescription drugs
• Rehabilitative and habilitative services and devices

Healthcare coverage is confusing and questions don’t often arise until the moment we need medical care. All women expecting a new baby are urged to discuss their family situation with an administrator of employer and individual policies and with state administrators for the most comprehensive understanding of what is available and how to access it.


Sources:

1. “Protections for Newborns, Adopted Children, and New Parents.” United States Department of Labor / Employee Benefits Security Administration. US Department of Labor. n.d. Web. Feb 20, 2014.
2. “Fact Sheet / Why the Affordable Care Act Matters for Women: Better Care for Pregnant Women and Mothers (pdf).” National Partnership for Women & Families. National Partnership for Women & Families. Sep 2013. Web. Feb 20, 2014.
3. “What does Marketplace health insurance cover?” HealthCare.gov. US Centers for Medicare & Medicaid Services. n.d. Web. Feb. 20, 2014.