The XX Factor

How Trumpcare Could Harm Pregnant Women

Please don’t make this any harder.


A federal government helmed by Donald Trump, Mike Pence, and Georgia Rep. Tom Price, the president-elect’s recent selection for secretary of health and human services, is not one women can count on. Our bodies are now at the mercy of a group of men who are anti-contraception, anti-abortion, and anti-Obamacare—legislation that prevented insurers from treating lady parts like an inconvenience.

Some women are preparing for a potentially draconian future by getting long-acting birth control such as IUDs before they become more expensive for many and possibly illegal for all. Unfortunately for pregnant women, or those who would like to become so in the next four years, there is no such 11th-hour measure available. Many of us, including this five-months-pregnant writer, have no choice but to have our babies in the next four years, during which time maternity and pediatric care might become less comprehensive and more expensive.

The Affordable Care Act, which Trump and Price have promised to scrap, substantially improved maternity coverage. Before Obamacare, many insurers didn’t cover maternity care. A 2013 report from the National Women’s Law Center found that just 12 percent of individual market plans included maternity benefits. Insurers often charged women more than what they charged men for the same coverage, even if the policy didn’t include maternity care. Also, pregnancy was considered a pre-existing condition, meaning that it could prevent women from getting insurance in 45 states. The average birth in the United States costs $18,329. Before Obamacare, most group plans, which the majority of Americans are on, were required to cover maternity care under the 1978 Pregnancy Discrimination Act.

Obamacare made maternity care one of the 10 essential health benefits that all individual plans must cover. All plans offered on the marketplace are now required to cover pregnancy, maternity, and newborn care, and most of them are also required to cover additional preventive services, including screening for gestational diabetes and breast-feeding support and supplies such as breast pumps. The Affordable Care Act also amended the Fair Labor Standards Act, which covers most hourly wage–earning and some salaried employees, to require employers to better accommodate nursing employees. These workers “must be given ‘reasonable’ break time to pump for a breastfeeding child, as frequently as needed by the nursing mother, for up to 1 year after the child’s birth” and be provided with a private space to pump that is not a bathroom. Lastly, Obamacare also funded initiatives aimed at reducing preterm birth, which have so far been effective.

The Affordable Care Act also improved pediatric care and required that all marketplace plans and many others cover things such as vaccinations, behavioral assessments, and autism screening. Newborns are now guaranteed preventive gonorrhea treatment as well as screening for congenital hypothyroidism, hearing problems, phenylketonuria, and sickle cell anemia.

As Sarah Kliff points out at Vox, Price’s plan to replace Obamacare, the Empowering Patients First Act, “eliminates the essential health benefits package, which mandated that all insurers cover a set of 10 different types of care including maternity services and pediatric care.” Paul Ryan’s comparatively more generous plan does the same.

Anti-abortion activists like Price tend to cloak their beliefs in a desire to protect “innocent human life.” But their previous inaction and current silence on making sure every pregnant woman and newborn is provided with high-quality maternity care suggests otherwise. Perhaps they will surprise us all and proceed in a more consistent manner, bringing equal fervor to their protection of the fetuses of women who choose to have abortions as they do to those fetuses of women who would like to count on safe, and affordable, pregnancy and delivery. Unfortunately, we’ve got little reason to believe that this will be the case.