LAUSR

eginning in January 2014, the Affordable Care Act B(ACA) required that all health insurance plans offered by individual and small-group markets, public and private health-care exchanges, and Medicaid include a comprehensive package of essential health benefits (EHBs) and be certified as having them. At aminimum, according to the law and subsequent US Department of Health and Human Services guidance, EHBsmust include items and services in 10 categories, one of which is maternity and newborn care. Before the ACA was enacted in 2010, only 11 states required coverage of maternity benefits in individual health plans. Consequently, only 13% of individual health plans included maternity coverage. Under some plans, past pregnancieswere considered a preexisting condition, which disqualified some women; in other cases, maternity care was covered only through costly insurance riders. Prior to the ACA, one estimate is that only 12% of health plans offered in the individual market included comprehensive maternity benefits. Because nearly one half of all pregnancies are unplanned, some women would find themselves in insurance plans that lacked maternity coverage. For women without any insurance coverage, the cost of maternity care is high. Maternity care, including labor, delivery, and postpartum care, has been estimated to cost more than one half of awoman’s annual income. In 2010, the cost of an uncomplicated vaginal birth was $15,300 and that of a cesarean delivery was $20,400, adjusted for inflation. Pregnancies with complications cost even more. For example, pregnancy-related hypertension, which affects up to 10% of pregnant women, could cost an uninsured patient $18,562, and a postpartum hemorrhage could cost an additional $21,275. Before the advent of the ACA, even women with maternity care coverage could be exposed to high deductibles, coinsurance, or prolonged waiting periods to use available benefits, further shrinking access to maternity care. Moreover, some insurance plans did not cover all services related to pregnancy and delivery, or some maternity care providers were not within an approved list of providers. One example involves