ACA upheld!

I am happy and relieved that the Affordable Care Act was upheld today - for both public health and doula-related reasons! To illustrate just a few of the reasons why, I point you to this article from the American College of Nurse-Midwives:

Before implementation of the new health care reform provisions, many uninsured young women have not been eligible for Medicaid or other insurance coverage until becoming pregnant. For example, a nine-state study found that from 17 to 41 percent of childbearing women lacked insurance prior to pregnancy, with 13 to 35 percent transitioning to Medicaid at some point during pregnancy (3). Lack of insurance before pregnancy has limited the ability of a large segment of childbearing women to use health services to plan a successful pregnancy. ...Three PPACA provisions will dramatically change this situation.

Preconception care is a huge issue. Many pregnant women end up getting access to coverage via Medicaid, but there is only so much prenatal care do when you already had poorly controlled diabetes and high blood pressure prior to pregnancy.

In the past, uninsured pregnant women have largely been ineligible to purchase private insurance or, if they could purchase insurance during their pregnancies, the coverage generally did not include maternity care for the present pregnancy. More recently, some insurers have deemed women who had a previous cesarean birth to be ineligible for maternity care coverage (6), and there are anecdotes of similar practices, such as excluding coverage of pelvic floor problems among women who have had an episiotomy. Such practices will be illegal in 2014.

This is huge! It is essentially impossible for pregnant women to buy health insurance; if you don't qualify for Medicaid, you are totally out of luck. The denial of coverage to women who have had prior c-sections is hugely problematic, and will be banned along with other "pre-existing conditions".

In recent years, Medicaid beneficiaries in some states have lost access to birth center coverage, and many freestanding birth centers have been threatened with closure due to loss of Medicaid reimbursement. Although birth centers have traditionally been reimbursed within Medicaid programs, some state Medicaid programs had recently begun to deny birth center claims and legislation had not mandated such coverage for Medicaid beneficiaries. A PPACA provision requires coverage of care in freestanding birth centers that meet state regulatory requirements, beginning in 2010.

Straightforward and much-needed. Birth centers are part of making care more effective and affordable!

Beginning in 2010, all new health plans are required to offer, at no extra cost to the patient, all services and screenings recommended by the U.S. Preventive Services Task Force. For childbearing women, the recommended services include folic acid supplementation, breastfeeding counseling before and after birth, tobacco use counseling, and screening for several conditions

This includes reimbursement for lactation consultants!

The act directs employers to provide new mothers with a reasonable break time to express milk for a nursing infant for 1 year after the birth and a private place that is not a bathroom for doing so.

This is one of the provisions that very few people outside the breastfeeding advocacy community paid a lot of attention to, but one of the things that will make a HUGE difference for pumping moms in the workplace. People I know who work with universities who are building out their campuses say that they are hearing more and more about making sure that every building has a mother's room. There is so much more - some that not even I was aware of. Read it here!"