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If Congress wanted to design a health care system that would poorly serve pregnant women and infants, repealing the Affordable Care Act without repairing or replacing it would be a good start.

Since January, both the House and Senate have tried to enact major changes to our health care system, especially for low-income people served by Medicaid. Too little attention has been paid to the fact that those proposals would fail badly to address the needs of pregnant women and babies, especially those born sick or too soon.

Repealing the ACA would immediately return us to the untenable status quo that existed before 2010, when insurance coverage was often skimpy and expensive, especially on the individual market, which sells health plans to those who don’t have insurance through work or public programs. Before the ACA became law, only 13 percent of all plans offered on the individual insurance market routinely covered pregnancy. Only 11 states had laws on the books requiring plans to include maternity coverage. That meant pregnancy was usually a costly rider for those purchasing individual coverage.


The American Congress of Obstetricians and Gynecologists recommends that all women receive regular checkups throughout pregnancy. Infants require an intense schedule of well-child visits to provide preventive care and guidance to parents, as well as to track healthy development. If those regular checkups during pregnancy and infancy don’t happen, problems can start to build quickly. And those problems can have costly human and economic implications over a lifetime.

Universal coverage for pregnancy is especially important considering that about half of all pregnancies in the U.S. are unplanned. Before the ACA, women could easily have purchased insurance plans that didn’t include pregnancy coverage, only to find they needed it part way through the plan year and would have to pay out of pocket for all prenatal and maternity care.


That changed with the ACA. It required all plans on the individual market to include coverage for maternity and newborn care, along with nine other sets of essential health benefits. As a result, women and their partners no longer had to wonder if their plans covered pregnancy. It was guaranteed.

But this situation is set to change if the current efforts to repeal the ACA are enacted. We could return to the “bad old days” prior to 2010, when individual market plans didn’t have to cover maternity and newborn care. It would force women to pay for expensive pregnancy riders or pay for their maternity care out of pocket.

A new analysis released by my organization, the March of Dimes, and supported by Avalere Health shows how this would work. Under the ACA, an average pregnant woman — I’ll call her Kate — has estimated premiums in the individual market of just under $3,000 (although she could pay much less if she qualifies for subsidies.) Kate’s insurance pays her health care providers an average of about $7,500 for care during her pregnancy, of which her share is about $4,000. For her entire pregnancy, Kate’s out-of-pocket costs can’t exceed $7,150. While considerable, these costs would generally not be considered catastrophic. Depending on her plan and her eligibility for assistance with premiums and cost-sharing, her expenses could be much lower.

If the ACA is repealed and maternity and newborn care are no longer required to be covered, things quickly get more complicated for Kate. First, for coverage that includes pregnancy, her premiums skyrocket, increasing by anywhere from 25 to 70 percent. Just as important, the ceiling on out-of-pocket costs is lifted. Suddenly, Kate and her family are on the hook for unlimited out-of-pocket costs, which could potentially total tens of thousands of dollars.

Kate might opt for — or have no choice but to accept — a plan that doesn’t cover maternity care, in which case her average premiums would drop by $10 per month, or $120 per year. But under this scenario, if she does get pregnant, she’s in dire circumstances. Kate is then responsible for the entire cost of her prenatal and maternity care, as well as any care her newborn needs. For a healthy pregnancy, that would be an average of $15,000 in out-of-pocket costs. If Kate or her baby need special care, that could easily run into tens or hundreds of thousands of dollars. If Kate has twins born very premature, her costs could exceed a million dollars.

It doesn’t have to be this way. Our nation has a collective obligation to ensure that all women have healthy pregnancies and healthy babies, because these children represent our future. By pooling risk and having everyone contribute to the health care system, we can ensure that women and babies get the care they need without being crippled by medical bills.

We can do better. Congress should go back to the drawing board and work in partnership with patient groups like the March of Dimes and other stakeholders to craft a plan that seeks to provide affordable, quality health coverage to all Americans, including all pregnant women and infants.

Stacey D. Stewart is the president of the March of Dimes.