Under the Affordable Care Act, people up to age 26 are eligible to qualify as dependents on their parents' insurance policies. This is great news if you're one of the thousands of newly minted graduates wallowing in un- or underemployed post collegiate hell, but it's less awesome news for women who, in their prime reproductive years, might find themselves SOL if they get pregnant — parental insurance plans, as a general rule, do not cover abortion or maternity costs. Better double up on both the Ortho Tri Cyclen and condoms, ladies. If you get knocked up while you're still on your parents' plan, you're both literally and figuratively fucked.
Employer-sponsored insurance plans aren't allowed to discriminate against women by refusing to provide maternity coverage, thanks to the Pregnancy Discrimination Act of 1978. But no such rules apply to dependents of insurance policy holders. Pre-Affordable Care Act, this unpleasant reality only hit families with a teen daughter who got pregnant. But now that more women are spending the better half of their twenties as "dependents," a lack of prenatal care coverage can be financially devastating for an entirely new swath of the population.
According to the Washington Post, in 2008, 2.8 million women between the ages of 15 and 25 got pregnant. Some opted to carry the pregnancy to term; others terminated or had a pregnancy that ended due to natural causes. But almost all of them required some sort of medical intervention. And having babies ain't cheap — the Post reports that each uncomplicated pregnancy, from conception to delivery, costs more than $10,000. And a woman who doesn't receive adequate prenatal care — say, a teenager whose parents' insurance doesn't cover it — is much more likely to deliver prematurely or experience complications, which can add several thousands more dollars to the bill. A whopping 70% of insurance plans don't cover prenatal care or childbirth for non-spousal dependents. And these women who seek assistance from Medicaid are often denied as well, since living under their parents' roof or on their insurance plan may mean that their household income is too high to qualify for government aid.
But do private insurance plans cover abortion services for minor dependents? I reached out to the National Women's Law Center about abortion coverage for the children of policy holders, and while the NWLC doesn't have hard and fast numbers, according to Guttmacher, most non-government employees currently enjoy abortion coverage as part of their employer-provided insurance coverage. Anecdotally (and you know how reliable anecdata is!), my former employer, a large financial institution, covered abortion for policyholders and their spouses, but not for dependent children. The same restriction holds true for the insurance policy at my current employer.
Monday morning quarterbacks (Monday morning OB/GYN's?) would be quick to point out that if a woman doesn't have the money to pay for childbirth out of pocket and is still on her parents' insurance, then maybe she shouldn't be having potentially babymaking sex in the first place. A fair point, if you believe that sex should be something that's only available for people who can pay for every possible outcome of sex every time they have it — although something tells me that if a young man broke his penis during intercourse and found that his parents' insurance plan wouldn't cover his dick repair, there'd be a lot less tongue clicking moralizing and "maybe think of that before you have sex, you little strumpet!"s.
This issue should be disconcerting for a few reasons: first, as a person who considers herself "pro-choice," I am pro women being able to make the right choice for themselves, be that childbirth or abortion. Coerced abortion and coerced pregnancy are both deeply upsetting. And insurance plans that refuse to provide either childbirth or abortion coverage (or that cover abortion services but not pregnancy-related costs) for plan dependents are essentially making women's choice for them — when presented with the option of spending between $300 and 1,500 on an out-of-pocket early term elective abortion or spending upwards of $10,000 on childbirth, the "choice" stops looking like a "choice" and starts looking a lot more like financial coercion. Unless you're incredibly privileged, getting pregnant while dependent essentially leads to a choice between abortion/financial independence or childbirth/financial ruin.
Young women who get pregnant already start out behind the 8 ball. Allowing insurance companies to issue policies that deny prenatal coverage to dependents only adds to the burden of young motherhood, cruelly turning one of the Affordable Care Act's most attractive provisions into something that's neither affordable nor caring.