Informer: Maternity care not reason for scuttled policies

By By Andrew Perzo / American Press

Is it true that most of the insurance cancellations are because one of the clauses of Obamacare is that everyone has to carry

prenatal in the policy?


The Affordable Care Act lists maternity

and newborn care among the 10 “essential health benefits” categories

that insurance

plans must cover. But inclusion of services under that category

alone isn’t the reason for the cancellation notices that have

been sent to individual purchasers in recent weeks.

The primary reason for the cancellations is the policies weren’t subject to the ACA’s grandfather clause, which The Informer

wrote about in September 2012.

Under the grandfather clause, plans that existed on March 23, 2010, when the ACA was signed into law, were exempt from most

of the health care reforms as long as the policies didn’t undergo significant changes — such as large shifts in cost share

or a sharp reduction in benefits.

Some canceled policies were undone because they changed, losing their exempt status. Others were canceled because they were

purchased after March 2010 — meaning they never were exempt — and didn’t comply with the ACA’s requirements, including the

essential benefits provision.

Those essential benefit categories, according to

Ambulatory patient services.

Emergency services.


Maternity and newborn care.

Mental health and substance use disorder services, including behavioral health treatment.

Prescription drugs.

Rehabilitative and habilitative services and devices.

Laboratory services.

Preventive and wellness services and chronic disease management.

Pediatric services, including oral and vision care.

“Most policies in the individual market

are not ‘grandfathered’ and therefore have to come into compliance with

the ACA requirements

starting on January 1, 2014 or when those policies renew

throughout the year,” reads the website of America’s Health Insurance

Plans, an industry group.

“The primary reason most policies are

not grandfathered today is because people chose to change their policies

or purchased

new coverage after the law was enacted. According to regulations

released by (the Department of Health and Human Services),

‘between 40 percent and 67 percent of policies are in effect for

less than one year’ and ‘the high turnover rates described

here would dominate benefit changes as the chief source of changes

in grandfather status.’ ”

President Barack Obama on Thursday

announced that the administration would permit insurance companies to

offer non-ACA-compliant

policies for an additional year if they wanted to. U.S. Sen. Mary

Landrieu, D-La., is pushing a bill that would require insurers

to renew the policies.

The House on Friday passed a

GOP-sponsored plan to allow insurers to renew the canceled plans and to

keep selling low-cost,

bare-bones policies that don’t comply with the ACA. The president

has threatened to veto the bill, which isn’t likely to get

through the Senate.


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The Informer answers questions from readers each Sunday, Monday and Wednesday. It is researched and written by Andrew Perzo, an American Press staff writer. To ask a question, call 494-4098, press 5 and leave voice mail, or email