Letter to Mrs. Seema Verma, CMS Administrator Nominee - Protection of Women's Healthcare

Letter

Dear Mrs. Verma:

We write to express our deep concern about your commitment to protect quality, affordable health care for women and to address disparities in health care quality and access. In addition to other concerns, your recent comments concerning maternity care during your confirmation hearing raise real questions about whether you would enforce current legal protections for women's health. During your confirmation hearing before the Senate Finance Committee, you were asked if women should get access to prenatal care and maternity coverage, as afforded under the Affordable Care Act (ACA) or whether insurance companies should get to choose whether to cover this for women. Your response indicated that coverage of prenatal and maternity care should be optional -- in direct contrast to the law and the care that women and families receive today.

Not only was your response inadequate, it reflects a fundamental misunderstanding of an individual's ability to make health care decisions when no options are made available to them, as was the case before the ACA. If no plan offers maternity coverage, and if coverage is extraordinarily costly or requires long waiting periods, what kind of choice does that present to women?

If confirmed as Administrator of the Centers for Medicare and Medicaid Services (CMS), you would be responsible for overseeing programs that serve over 100 million Americans, including women and families, who access health care services through Medicare, Medicaid, CHIP and the Marketplace. When further pressed at your confirmation hearing whether women should pay more for health insurance, you mentioned that you "think that women have to make the decisions that work best for them and their family." We agree. However, we know that women and their families are better able to make such decisions when they have access to maternity care coverage, which is why we fought hard to make that care accessible for millions of women and families through the ACA.

If confirmed as Administrator, it would be your job to enforce and implement the law. For this reason, we think it's important you do some research and increase your awareness about how life was for women seeking health care before the ACA became the law. Prior to the ACA, women who purchased their own insurance were unlikely to find coverage that included maternity care. According to the National Women's Law Center, in 2013, just 12% of individual market plans offered maternity benefits. If maternity coverage was offered, it was often as an expensive rider with a waiting period, limiting the options of women to afford pregnancy care and plan families.

Even with maternity coverage excluded, before the ACA, 92% of plans charged women more than their male counterparts for coverage, a practice known as "gender rating." Insurers often treated pregnancy as a pre-existing condition, allowing them to raise premiums for, or deny coverage to, expectant parents. According to a 2013 report by Truven, the average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section.

Today, maternity care is a federally mandated essential health benefit that must be included in all individual and small group plans, as prescribed under statute. Insurers can no longer charge women higher premiums simply because of their gender, and every plan, inside and outside of the exchanges, must offer maternity care. These are huge strides towards ensuring that women and their families, and not their insurers, are able to make important decisions about their reproductive health and family planning.

Going back to the time when insurers were in control, and maternity care was an optional benefit, will lead to worse health outcomes for women. We urge you to commit to enforcing current law requiring maternity care to be covered by all insurance plans for all women, and commit to protecting the benefit if confirmed. Our hope is that you will stand with us in ensuring that women have full access to maternity care.

Sincerely,