The Bun In The Oven & The State of Preventative Health

Here are some snippets from an email I received from the US Department of Health and Human Services today:

"We know that the health care crisis impacts every American, but our mothers, daughters and sisters are paying a particularly heavy price. Today, 21 million women and girls are uninsured. Women who try to purchase insurance find that the private market is often stacked against them. Premiums in the private market for young women are often higher than they are for men. In some states, insurance companies can legally discriminate against women, and leave them with higher health care bills or inadequate coverage.

We know America's women can't afford to wait for comprehensive health reform. Roadblocks to Health Care reports:

• In the individual insurance market, women are often charged higher premiums than men during their reproductive years. Holding other factors constant, a 22 year old woman can be charged one and a half times the premium of a 22 year old man.
• In a recent national survey, more than half of women (52%) reported delaying or avoiding needed care because of cost, compared with 39% of men. "

Why are women charged more?
Among other things, because we can get pregnant and pregnancy in the US is very expensive. We therefore use more health care and are charged more or denied insurance coverage. But here is the crazy part, folks: women cannot self-impregnate!

Not long ago, I received a very personal lesson on the wacky state of preventative health care for maternity. As an otherwise extremely healthy person with a good track record for taking care of myself and little in the way of worrisome health risks, I'd gone the way of financial prudence. I purchased a health plan with a high deductible, but with inexpensive co-pays on doctor's visits and alternative medicine as well as discounts on pharmaceuticals should I need them.

This was all working out very well. I continued to do my part for the team by taking good care of myself, paying my insurance company dutifully and not using any medical care! I was mentally prepared should a catastrophe befall me. I figured, should that happen, my piddly $5k deductible would seem like chump change in comparison to what I would otherwise have had to spend out of pocket for catastrophic care. All those years of paying unused premiums to my carrier would have been put to good use!

Then, about 6 months ago I developed a small "medical" problem. That's right. I got pregnant. Ok so this is no catastrophic illness or disease condition, right? I mean, there are more than 6 billion people on earth and unless I am mistaken pregnancy is the way we all got here. As a scientist I will grudgingly agree that pregnancy looks suspiciously like a highly evolved parasitic infection. Yet, unlike malaria - for instance - my health plan wasn't ponying up any cash for pregnancy vaccines or other preventative measures against this "disease."

So it was one $20 co pay with my primary care doc, the cost of a pregnancy confirmation test and then I was on my own. At that point my options were to start clocking maternity care against my catastrophic deductible. After meeting that limit I'd pay 30-70%. After doing the math I realized that if I ended up in a hospital for a routine, healthy birth with no serious complications that I would most likely end up paying $7,500+ out of pocket for my "disease."

Compare this to a $2000-2500 bill if I pay cash for a home birth with a certified nurse midwife including all prenatal scans and labs and two months of well baby care and it left me scratching my head. Now if there were complications (need for surgery, premature birth, gestational diabetes, preclampsia, etc.) that led to a need for emergency medical intervention then, as I said, there is not much room to gripe over the deductible when so many dollars and someone's life is on the line. Yet when all signs in my case (and in the case of nearly 75% of pregnancies that come full term) point to a completely normal, healthy pregnancy and birth I am perplexed about how this situation serves any sort of greater good.

In my case I simply opted to pay the midwife out of pocket and should an emergency arise, well, it's an emergency - deductible be damned. Yet I think about all of the women whose partners may have left them; women whose partners lost their jobs; women who have lost their own job and are not sure how to afford COBRA, but would be denied individual coverage due to their "pre-existing condition"; women who are short on the cash to be able to afford the relatively less expensive but still cost prohibitive bill for good prenatal care and who end up with very costly bills later on down the line due to having delayed or avoided care.

And these mothers who were impregnated by partners who - in most cases - will not be denied coverage or see rate increases due to their partners' "disease," are left unable to pay and to pass on the costs to the remaining payers in the current insurance system - thus becoming contributors to the astronomical rise is insurance rates. These are not some handful of bad people "out there." If you are reading this blog, breathing and have a pulse right now then you have a pregnant woman to thank.



People are not going to stop making more people, people. It just isn't going to happen. So what are our options when it comes to taking pregnant women off of the bad apple list with regards to health care costs?

1. Provide safe, effective and affordable contraception and family planning services to women of reproductive age (yes, this means after menarche) .
2. Ensure that pre-natal care is covered as preventative care under health plans.
3. Stratify pregnancies by risk and ensure that health plans cover lower cost but safe and effective birth options such as licensed birthing centers and midwife assisted home births for low risk pregnancies.
4. Ensure that health plans rapidly identify and direct high risk pregnancies to maternity care and coaching programs that help manage behavioral risk factors and more closely monitor pregnancy through birth.
5. If you are en employer providing maternity benefits and health insurance for your employees and spouses, make sure you emphasize prental care and maternity benefits offered by your health plan. Consider setting aside lactation rooms to encourage breastfeeding mothers to pump so that they can continue to feed their babies breastmilk (which has health benefits for the mother and child).
6. Support legislation that accomplishes all of the above and funds community health education centers that provide outreach, education and services to uninsured populations - eliminating a cost barrier which might keep pregnant women from seeking care until it is too late.
   

If altruism isn't your bag, then consider that early prenatal care helps all payers in the health insurance game by lowering costs shared by the pool. And if you are still feeling the glow from that gift that had your mom in tears last weekend, then - hey - do it for the lady who loved you enough to endure nausea, swollen feet, ill-fitting clothes and a whole lot more to bring you into this world.