The Department of Health and Human Services (HHS) has denied a request from Democrats to create a special open enrollment period under the Affordable Care Act for women when they find out they are pregnant.
In a response to the March letter sent by Senate Health, Education, Labor and Pensions (HELP) Committee ranking member Sen. Patty Murray (D-Wash.) with 36 signatures, HHS Secretary Sylvia Mathews Burwell said the agency does not have “the legal authority to establish pregnancy as an exceptional circumstance” to create a special enrollment period.
Burwell said pregnant women could enroll in Medicaid and the Children’s Health Insurance Program (CHIP).
“Women with low and moderate incomes can enroll in these programs at any time if they qualify,” she wrote. “And, like all other qualified individuals, pregnant women can enroll in the Marketplace during the annual open enrollment period.”
Lawmakers originally asked for the special enrollment period in an effort to address what they called a gap in coverage that could leave women without access to maternity care.
“Good maternity care is essential for the well-being of children, and studies show that maternal mortality rates are three to four times higher for women who do not receive prenatal care,” said the letter to HHS, signed by Sens. Ron Wyden (D-Ore.), Kirsten Gillibrand (D-N.Y.), Barbara Mikulski (D-Md.) and Tammy Baldwin (D-Wis.).
Without health insurance, lawmakers said, women will either be forced to forgo this critical care or face lofty out-of-pocket costs.
In a statement to NPR in February, Burwell said HHS had not included pregnancy as a qualifying life event because it was following insurance companies in determining open enrollment periods.
But she said then that HHS was open to considering the issue.
“It is absolutely critical that all pregnant women have access to health care coverage, so I am disappointed by today’s announcement,” Murray said in a statement last week. “I will continue looking for ways to get this done so that more women can get covered and get the affordable, high quality care they need for themselves and their young children.”
In a statement, the Jen Mishory, executive director of Young Invincibles, a millennial advocacy group, said she too is “disappointed” in the administration’s decision to leave pregnant women vulnerable during a life–changing event.
“The administration has the authority to create special enrollment periods in cases like these, but is instead ignoring the calls to protect women’s health of nearly 100 members of Congress, over 100,000 consumers, and dozens of organizations to do so,” Mishory said. “The administration has named many extraordinary circumstances qualifying life events for special enrollment, and there’s no reason — legal or otherwise — they cannot do so here.”