CR: Why should a childless man have to buy maternity coverage? It’s all about sharing the risk

Cross-post from Nancy Metcalf at Consumer Reports. See the original post here.  My hat is off to Ms. Metcalf – this is the best short moral and policy explanation of why we have health insurance that I have read in a long time. It’s worth reading all the way to the end. 

Q. I’m a middle-aged man with no intention of having children. Why should I have to pay for maternity or pediatric dental coverage?

A. I’ve been getting this question a lot (most recently from Dr. Sanjay Gupta during a recent appearance on his weekly program). It refers to the fact that as of 2014, all individual and small group insurance plans sold in the U.S. must cover those services as “essential health benefits.” Here’s why.

Health insurance, like all insurance, works by pooling risks. The healthy subsidize the sick, who could be somebody else this year and you next year. Those risks include any kind of health care a person might need from birth to death—prenatal care through hospice. No individual is likely to need all of it, but we will all need some of it eventually.

So, as a middle-aged childless man you resent having to pay for maternity care or kids’ dental care. Shouldn’t turnabout be fair play? Shouldn’t pregnant women and kids be able to say, “Fine, but in that case why should we have to pay for your Viagra, or prostate cancer tests, or the heart attack and high blood pressure you are many times more likely to suffer from than we are?” Once you start down that road, it’s hard to know where to stop. If you slice and dice risks, eventually you don’t have a risk pool at all, and the whole idea of insurance falls apart.

It’s worth noting that virtually all employer plans cover maternity care for exactly this reason: a unified risk pool. And no one seems to complain about that, for some reason. Moreover, we are all paying taxes to support Medicaid, which foots the bill for nearly half of all live births in the U.S.

There’s another reason we know that buying insurance a la carte doesn’t work: we’ve already tried it with maternity care. Before the new health law took effect, insurers can and did exclude maternity coverage from individual plans. In fact, in half of states you can’t purchase maternity coverage on the individual market for any price. In most of the rest, you can buy a maternity rider on your policy. In many cases it costs more than the main policy itself, and you can’t use it for at least a year after you buy it, and it often has a separate deductible of up to $5,000.

Why so expensive? Because the only people who buy it are, naturally, people planning to have a baby. Insurers know this and price accordingly. As a consequence, this maternity “coverage” costs just about as much as paying cash for having a baby, which means it’s coverage in name only. (Thanks to the National Women’s Law Center for this data, from its 2012 report entitled “Turning to Fairness.”)

Also, presumably at some point you, yourself, were born. Would it have been ok for your mother not to have insurance for childbirth, which can cost as much as $30,000 for an uncomplicated delivery? The U.S. already has the highest infant mortality rate of any rich industrial democracy. Do you think it’s good for society for some families not to have access to proper prenatal care? The babies thus born are going to be paying for your Social Security one day, remember.

Got a question for our health insurance expert? Ask it here. It helps if you include the state you live in.

— Nancy Metcalf

18 Comments

  1. Adam Linker

    November 8, 2013 at 8:38 pm

    In NC you couldn’t get a maternity rider, at any price, once you got pregnant. So you had to buy maternity coverage just in case you got pregnant, which would cost several thousand dollars every year.

  2. LayintheSmakDown

    November 8, 2013 at 9:58 pm

    Good old Socialist mentalities!

  3. ML

    November 9, 2013 at 12:46 pm

    Good old selfish republicans

  4. LayintheSmakDown

    November 9, 2013 at 3:31 pm

    Oh wait, that was me….maybe…..I was just showing how easy it is to do a pseudonym on this site. Maybe. or am I ML, or Alan, or Layinthesmakdown?

  5. LayintheSmakDown

    November 9, 2013 at 3:41 pm

    An good ole’ progressive views knowing no bounds on other people’s stuff. We see how well that works with all the socialist nations that are currently viable…oh wait bad example.

  6. Alan

    November 9, 2013 at 6:31 pm

    Socialist nations that are currently viable?? What about Sweden, Norway, & Finland? I guess being European makes them socialist in your book. All 3 doing rather well…

    Perhaps if you got your ignorant rear-end out of here and actually traveled & experienced other cultures you’d be a little more informed?

  7. Alex

    November 11, 2013 at 7:27 am

    What a total bunch of malarkey this is ! Insurance has always been based on the risk associated with each individual. All of liability insurance such as automobile, property,fire,etc. is based on individual risk factors. Why would I as a safe driver want to pay for a reckless driver with multiple accidents. The same is true for life insurance where I would not want to pay higher premiums to cover a person who wants to smoke and eat himself to death. There is no reason for health insurance to be any different. I don’t want to be held accountable for someone else’s decisions, nor do I want them to subsidize me.This “share the misery” mentality just baffles me.

  8. Doug Gibson

    November 11, 2013 at 1:08 pm

    Seems like someone missed this bit:

    It’s worth noting that virtually all employer plans cover maternity care for exactly this reason: a unified risk pool.

    Look at all those “job creators,” pooling risk! Who knew they were all socialists?

  9. Frances Jenkins

    November 11, 2013 at 5:41 pm

    In North Carolina, 278,000 have lost insurance coverage. Thousands more are paying double rates. People are mad as hell. They could gave a rat’s rear if Governor McCoury speaks off the talking points or Art Pope is dictating policy. They know they have lost coverage, they have been lied to by the government, and the Democrats are the cause.

  10. gregflynn

    November 11, 2013 at 7:31 pm

    500,000 low-income people could have been covered by Medicaid expansion but Pat McCrory, Thom Tills and Phil Berger rejected it.

  11. Frances Jenkins

    November 11, 2013 at 7:54 pm

    So that justifies 278,000 more people in NC losing their insurance and more than 40% paying double to triple rates. Only one person in NC has actually registered for ACA.The defeat of Hagan will be a greater price for Greg Flynn. Walk down Main Street and force yourself to talk to average and real poor folks. Feel their wrath and their anger. The loss of trust in government and seeing first hand Democrats and Obama lie openly and knowingly will be a great loss to a two party system and democracy.

  12. ML

    November 11, 2013 at 8:33 pm

    Frances Jenkins completely misses the point to double down on her original point without addressing Greg’s rebuttal. You can’t pretend outrage for 278k people and cheer the governors denial of coverage to 500k. Do you understand why you have no ground to stand on while you cheer one and show outrage towards the other? The answer is your ideology and bias, not that we all don’t have the same tendencies but some of us can identify the clear hypocrisy within our own logic and realize that neither outcome is ideal. On one hand mccrory refused to expand Medicaid hurting the poor that were unable to afford insurance. Conversely, Obama and the democrats sought to improve the health care system in the US but have made many missteps along the way. Neither outcome or decision has been ideal but your response is bread from your failure to understand your own bias.

    In the great words of Sam Cooke: “a change gonna come”

  13. ML

    November 11, 2013 at 8:38 pm

    I registered for the ACA. So that makes 2 plus I did it in one single Sunday morning before watching some football. Plus I’m a 27 yr old male paying for maternity coverage bc life is never fair and sometimes we don’t always get what we want.

  14. Frances Jenkins

    November 11, 2013 at 8:58 pm

    Taxpayer funded plans for Congress and their staff, mandates for certain groups postponed, this is not a fair America. Democracy must extend to all equally. You are drinking moonshine from Bluepoint .In Kentucky, 78% added were Medicaid and in California 72% added were Medicaid. Who in the h is going to pay for this government program? It will not be the working class because their hours have been slashed to 29 hours and policies doubled or tripled. Someone has to pay.

  15. Frances Jenkins

    November 11, 2013 at 9:14 pm

    According to the Wall Street Journal, about 50,00 have signed up for ACA. Currently, five million Americans have lost their health insurance. Health care and insurance are no longer affordable for many, many Americans. If seven million have to sign up by March, the program is in trouble. Hell will break loose on January 1 when millions more are without health insurance.

    Because of the failures of the ACA and the lack of participation, state will now have to pick up the extra cost of Medicaid. Count on it.

  16. Doug Gibson

    November 12, 2013 at 9:40 am

    Frances, dearie,

    Members of congress and their staffs get “taxpayer funded” health care because they’re government employees. They have employee contributions for their premiums, co-pays, and deductibles just like everyone else on employer plans (depending on the level of coverage they choose). I, for one, don’t begrudge Richard Burr or his staff the ability to buy health insurance as part of a pool that includes Elizabeth Warren and her staff. It simply makes sense to me, and I’m pretty sure it makes sense to Burr’s staffers as well. Maybe you should call them up and ask them how they feel.

    Five million Americans have lost their health insurance? You must be referring to the individual market, where close to half of plans are in effect less than six months, and almost two-thirds are in effect less than a year. Can you or your buddies at the WSJ tell me that every single one of those 5 million lost their coverage as a result of the ACA? Can you also guarantee that every single person in the remaining one third won’t find something better and cheaper on the state or federal exchanges? If you’ve got a study that says that (and includes the subsidies in the calculation), I’d love to see it, dear.

  17. ML

    November 12, 2013 at 11:09 am

    Frances, starting a post with “According to the Wall Street Journal” won’t get you too far here.

  18. ML

    November 12, 2013 at 11:13 am

    So we’ve tried the old way and that was a failure and now the heritage foundation/Romneycare idea is a failure (even though it’s about a month old), guess the next step is single-payer socialized health care.