In a sign of the growing health care crisis in California, the number of health insurance policies offering maternity benefits – from pre-natal screenings to birth – has dropped dramatically in recent years. In the aftermath of the failure of Arnold Schwarzenegger’s “Year of Health Care Reform” in 2007 all sides agreed to pursue greater regulation of the insurance industry as a stopgap before a broader solution was reached. And yet Arnold Schwarzenegger vetoed a bill that would have mandated insurance plans cover maternity.

About 805,000 Californians have insurance policies that specifically exclude maternity coverage – a number that has more than quadrupled from 192,000 in 2004, according to the California Health Benefits Review Program, which provides independent analysis of proposed health insurance benefits mandates.

“You see this tremendous jump in just a few years. That’s where we’re going with this,” said Assemblyman Hector De La Torre, D-South Gate (Los Angeles County), whose bill to require maternity coverage is headed to the Assembly Health Committee today. Insurance companies are “pushing these policies clearly onto people, and people are making their decisions based solely on dollars and cents.”

De La Torre’s bill, AB 98, would solve this problem. But Arnold has repeatedly vetoed the bill, including one by then-State Senator Jackie Speier in 2004.

The failure of insurance companies to provide these basic benefits is especially acute here in Monterey County. The Chronicle article linked above profiled Wendy Root Askew, a good friend of mine, whose experience typifies the problem that results from insurers’ refusal to provide basic maternity benefits:

When Wendy Root Askew of Monterey started looking for a doctor she hoped would be her gynecologist as well as deliver her future children, she was shocked to discover her health insurance policy didn’t include a single OB/GYN in her county.

The 31-year-old considered changing health plans. But then she learned that while 85 percent of the plans available in Monterey County offered maternity coverage five years ago, just 15 percent offer it now.

She found only two individual policies that included maternity, but they were three to five times as much as the policy she already had and came with annual deductibles of up to $15,000.

What the insurers that oppose AB 98 claim is that if a woman gets pregnant, she can purchase maternity benefits for an “additional sum”. Insurers claim this amount is small, but as Wendy found it is anything but small – it can be as much as five times the monthly cost of existing health insurance. A $15,000 deductible is essentially punishing women for getting pregnant, a stunning example of gender bias and inequality in an insurance system where prostate exams are routinely covered by basic plans.

Some insurers, and Republican opponents of AB 98 like Audra Strickland, claim that it would cost all Californians more money to mandate maternity benefits be included in all health insurance policies. And while that might mean a whopping average increase of $7 per month per policy (oh noez!) for Californians, the savings are actually much larger. Numerous studies show that proper prenatal care is vital to the long-term health of a child. By spending a little more per month to ensure all insurance policies provide expectant mothers with maternity benefits, we will be saving a far larger sum when their children turn out to be healthier.

Strickland in particular argues that it’s a matter of choice – if women want to get pregnant, they should choose to pay the extra cost. This is absurd on its face. By segmenting high-cost risks out of the insurance “market” you’re also actually undermining the entire system of insurance. Insurance is supposed to work by pooling the cost of risk, making it cheaper for everyone to get health care. By dumping the costs of pregnancy onto a small handful of people, health care costs actually soar, public health is undermined, and insurance as a system will go from a state of near-collapse to total collapse.

In reality Strickland, and Arnold Schwarzenegger, are arguing that the only “choice” here is whether one accepts that unless you’re wealthy or lucky enough to still have a job with group coverage, you’re going to not be able to afford to have a child. It’s typical conservatism – the rich can afford the basics of life, and who cares about those who cannot?

There is no plausible reason to oppose AB 98, and certainly no reason for Arnold Schwarzenegger to again veto the bill, unless he believes that society has no obligation at all to ensure that mothers and their children are healthy. And while AB 98 won’t solve the health care crisis itself – and it’s surely no substitute for true universal health care – it is a sensible and necessary move to provide gender equity and basic health care to mothers and children.

Over the flip is Wendy Root Askew’s testimony given to an Assembly committee on AB 98 last week.

My name is Wendy Askew and I am here to testify on behalf of AB 98 – the maternity services bill from Assemblyman Hector D La Torre. I would like to thank my representatives Assemblyman Bill Monning and Assemblywoman Anna Caballero for co-sponsoring this bill. I’d also like to introduce my husband Dominick, my mom Gail, my good friends Shirley and Jessica who are here to support me today.  

Recently my two sisters and I traveled to Santa Barbara to celebrate my mother’s graduation from a Master’s degree program in Pre and Perinatal Psychology.  We were slightly amused, but very proud, to sit in the audience as she presented her thesis on “Grandmother Connection”.  You should know that despite having three daughters in their mid to late twenties, my mother is not yet a grandmother; thus our amusement with the topic.

As a result, I decided it was time to start building a relationship with an OB-GYN who would eventually help my mom become a grandmother.  I was surprised to find that my insurance plan did not have one single contracted OB-GYN in my County.  However, I figured it was a good thing I had plenty of time to get a new insurance plan that actually included these doctors.

The real shocker came when my insurance broker explained that almost all of the plans offered in my County excluded maternity coverage.  I had a hard time swallowing the details of the only two plans that actually included maternity coverage.  It became clear that the risk pool for these plans was limited to women who intended to become pregnant and thus the plans were significantly more expensive than my current high deductible plan.

I felt I was an expensive liability that was going to drain our hard earned savings and saddle our family with medical debt.  I felt guilty for indulging in my dream of being a self-employed small business owner.  I felt like a second-class citizen at the mercy of decision makers who didn’t care about my health, dreams or goals.  The more I learned, the more disheartened I felt with the whole system.

Dominick and I take pride in being financially responsible.  Dominick is a self-employed licensed architect.  I started a fruit brokerage business.  We built a solid emergency fund. We set up and made regular contributions to our retirement accounts.  We each carried a high-deductible individual health insurance policy.  We live frugally, but very comfortably.  We made conscious decisions to build flexibility into our careers that would allow us to support our future family.  

For us, the issue of maternity coverage will be resolved when I accept a new job with a large employer who offers an excellent group insurance plan.  Ironically the new job will provide me with the maternity coverage I need to start a family, while ultimately preventing me from maintaining the work-life balance that will allow me to actually raise my family.  It will be difficult to leave behind a small company that I built, but my mother will be thrilled to know that at least one of her daughters has the relevant insurance coverage to make her a grandma!

I am here testifying before you today because the rules governing the Individual Health Insurance market, specifically as they relate to the exclusion of maternity coverage, preventing young couples like me and Dominick, from being able to start a family without the threat of financial ruin or dependence on state subsidized programs.  I’ve learned that the issues surrounding health reform are exceedingly complicated, and the solutions are riddled with trade-offs.  Without this legislation and without access to comprehensive individual health insurance that includes maternity, women face exceptional challenges as entrepreneurs or as stay at home mothers.

Thank you for allowing me to share my story today.  

Again I strongly urge you to vote for AB 98.