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Vanessa Gonzalez Kraft tries to balance her traditional Mexican-American cultural heritage and Catholic identity, personified by her grandmother La Lupe, with her roles as a young wife and mother.

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June 1st, 2011

Baby Boom 2014

 
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babyboom2014-flashLike any young couple with a growing family, Brandon and I have been discerning and having monthly conversations about when we should have our next child.  Recently, the following statement actually came out of my mouth, “Well, Obama’s health care reform will kick-in in 2014 and then we will be able to get maternity care on our insurance plan.  Maybe we’ll just have to wait until then.”

Wow.  As soon as I said it I was just so disgusted by the kind of system we have that would make it so hard to have kids.  Our family planning is going to be based on when a law goes into effect?  No way.  I refuse to be bullied by the insurance industry into letting it dictate our reproductive planning.

Our mailbox has been bursting at the seams with medical bills the last few months.  When I stop to think about all the money we have spent on medical needs in the last year it seriously makes me sick.  Granted, Lina is absolutely worth all the bills (those chubby cheeks are so irresistible,) but it doesn’t make the amount of money that is moving from our savings account to the hospital’s or doctors’ or Blue Cross Blue Shield’s pocket any less obscene.

When we got pregnant and found out our medical insurance didn’t cover maternity care, we definitely panicked at first, but eventually figured it out.  We talked to the hospital before we had Lina and, if we paid in full before the birth, they would give us a major discount.  Done.  Our doctor was very kind and gave us a bit of a discount as well.  It was going to be a lot of money but we were navigating the waters and saving a little here and there.  Additionally, our medical insurance covered Lina from the second she was born so we thought we were in the clear.

But then we got a bill from the hospital for Lina and all her expenses.  We called the insurance company and understood they were still trying to work it out.  Then we received a note on the bill saying that it had been processed by insurance, but we had to meet the deductible first.  Ugh.

We know how important it is to have health insurance, and have never gone one day without it.  We have been paying Blue Cross Blue Shield faithfully for years, and are prompt at sending them a check the first of every month.  And what did they do?  Not cover one cent of my pregnancy — no OB appointments, no ultrasounds, no lab work, no labor and delivery, no postpartum checkups.  Not even one single thing for Lina; not her lab work, shots, etc.

To be fair, this is exactly what the insurance told us they would cover.  It’s in the contract — the deductibles and the no maternity coverage.  So maybe we shouldn’t have been so blindsided.  But what gets me is that we live in a system that can leave a family so stranded for such an ordinary event.  We know insurance is important in case something catastrophic happens and I’m thankful for that security.  But all we did was have a baby — the most natural thing in the world, the natural fruit of marriage.  In the last 9 months, less than $2,000 has come out of Blue Cross Blue Shield’s pocket for all of us combined while we have paid over $15,000 for little Lina.

We are wiped out.  After all the tallying, we actually would have come out ahead if we hadn’t paid for health insurance over the last 9 months because then we would at least have kept the money we’ve been spending on monthly premiums.  People who believe health care reform and insurance reform is only going to help slackers or those who aren’t responsible for their family’s health, well, that’s really not true.

We didn’t go on a crazy spending spree.  We didn’t buy top of the line baby gear.  We didn’t vacation off the Mediterranean coast all summer.  We had a baby.  Should it really cost this much?  Should we live in a system where having a baby causes a family to go broke — not because of the cost of diapers or carseats or school and college, but solely because of the cost of having that baby?  (I know my frustration should also be aimed at the medical industry and the rising costs in this field.)

This is a serious pro-life issue.  There are so many people that are so vocal about being pro-life but I hear very few talking about actually supporting women who are open to new life and having babies.  They should be breaking down the doors of insurance companies making them cover pregnancies.  They should be lobbying the medical industry for lowering how much it costs to have a baby.  The way both of these industries are set up, they work in support of profits, not life.  No insurance company or group or individual is working toward pro-life goals if they make supporting new life so hard.

The coming of a new life into the world should not have to wait for 2014.  The planning for new life should be in God’s hands, not Blue Cross Blue Shield’s hands (or any other insurance company)  And I shouldn’t find myself praying that the healthcare reform isn’t repealed so that insurance companies will be forced to provide maternity coverage.

What are we going to do if I get pregnant again?  We flat out don’t have the money to pay for it.

God only knows when we will have our next child, but I’ll be darned if I let Blue Cross Blue Shield dictate it.

 
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The Author : Vanessa Gonzalez Kraft
Vanessa, a Notre Dame grad, loves the Catholic Worker Movement, Catholic education, and overbearing Mexican mothers, which she may or may not be. She lives in Austin with her husband and three daughters and is a freelance writer. You can find Vanessa at v.kraft.im or follow Vanessa on Twitter @laluped.
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Please note that the editorial staff reserves the right to not post comments it deems to be inappropriate and/or malicious in nature, as well as edit comments for length, clarity and fairness.
  • Sarah Yarr

    Come to Canada! Seriously. You don’t have to be a citizen to save money over the American system, because even non-citizens pay less in Canada than Americans do in the U.S. Also we do VBACs, midwives are legal and we have much better maternal and infant mortality rates. If you’re in the southern U.S. consider Mexico, their medical system is cheaper and they also have better maternal and infant mortality rates.

  • Greg

    Well we all know research isn’t cheap. And the Gov’t is broke. Sooo… That won’t get us very far.

  • Gage Blackwood

    Greg,

    Public Law 111-5 (American Recovery and Reinvestment Act of 2009, aka the Stimulus law that created the HHS panel).

    Sec. 804:
    (g) RULES OF CONSTRUCTION.—
    (1) COVERAGE.—Nothing in this section shall be construed
    to permit the Council to mandate coverage, reimbursement,
    or other policies for any public or private payer.
    (2) REPORTS AND RECOMMENDATIONS.—None of the reports
    submitted under this section or recommendations made by the
    Council shall be construed as mandates or clinical guidelines
    for payment, coverage, or treatment.

    PDF: http://www.gpo.gov/fdsys/pkg/PLAW-111publ5/pdf/PLAW-111publ5.pdf

    Public Law 111-148 (Patient Protection and Affordable Care Act, aka the Health Care Reform law) does two things – it eliminates the above panel upon the effectiveness and creates the Patient-Centered Outcomes Research Institute as an independent organization to, basically, do what the above government panel was made to do.

    Subtitle D establishes it: http://www.pcori.org/images/PCORI_EstablishingLeg.pdf
    It creates Sec. 1181 of the Social Security Act and includes as Sec. 1181(e)(8)(A)(iv):
    [The organization's research reports shall] (iv) not be construed as mandates for practice
    guidelines, coverage recommendations, payment, or policy recommendations.

    More info on this organization can be found on this website: http://www.pcori.org/home.html

    All of this research is already being done. The primary difference is putting some coordination in place to not duplicate effort.

  • Greg

    Gage-

    Have you seen in the law where it specifically says the 15 – member panel created by HHS is “to oversee research on the comparative effectiveness of various treatments, without regard to cost nor with any mandate forcing doctors to use it.”

    What I take from that is 15 bureaucrats deciding the basis of medical research. So they ultimately decide what treatments should be allowed and not allowed. Kind of scary have a panel of 15 bureaucrats deciding our healthcare options. I hope I get a waiver.

  • Gage Blackwood

    Matt,

    Again, can you cite the law?

    The Comparative Effectiveness Panel is a 15-member advisory panel created by HHS through the economic stimulus effort to oversee research on the comparative effectiveness of various treatments, without regard to cost nor with any mandate forcing doctors to use it.

    Regarding my birthing center idea:
    I think there is a great incentive to try it–if insurance companies are required to cover maternity and a less expensive but as effective course of action is available, why wouldn’t they try it? Just a personal opinion, but I’d venture that the health care industry would be most opposed as they would have the most to lose in such a situation.

    Friends in the military (another single-payer government system) who were pregnant were commonly referred to military midwives if their pregnancies weren’t high-risk and everything appeared to be normal. It saves everyone money (except the doctor/clinic taking in less).

  • Matt

    “Can you cite where birth control pills are mandated in the new law?”

    They’re not…by name. But any treatment which isn’t accepted by them as the most cost-effective for the given ailment (polycystic ovarian syndrome, in my wife’s case…treatable in most patients with really inexpensive birth-control pills) may not be paid for with government funds. Which I suppose is fine…if the government wants to refuse to pay for anything except birth control pills, then I’d be fine with continuing to pay for my wife’s medical care myself. Except that, beginning in 2014, it is a felony for a doctor to provide any treatment which isn’t on the “comparative effectiveness panel” approved list, whether or not the government is being asked to pay for it.

    So. Birth control pills, or no treatment at all.

    As for making childbirth less expensive, your idea is a great one. Too bad it’ll never be seriously tried, because there’s no incentive to try it. Everyone has to have insurance or be punished. Every insurance plan will have to cover all expenses of childbirth, or be punished. So who, exactly, is going to care about how much it costs to deliver a baby?

    Even fewer people than care about that today. And today’s number isn’t nearly enough to get things like that done.

  • Gage Blackwood

    Matt – I’m sure not what source you’re getting your information, but the last paragraph is not compatible with anything I’ve read from legit sources.

    I’ve learned not to trust the pundits on either end of the spectrum on this issue because they make up most of what they spew.

    The health care law does not create a single-payer system (e.g. turn over to the government); it adds various regulations onto the current health insurance industry and creates state-level marketplaces to make it easier to determine what plans are out there for people.

    Can you cite where birth control pills are mandated in the new law? The closest thing I’ve read is a physician’s board overseeing aspects of Medicare, which is a practically single-payer government system already, so I assume you’re not referring to this.

    I’m surprised that you mentioned leveraging BCBS by telling them you’re not going to pay for them. They’re not going to cover anything that isn’t legally mandated because their competition won’t either. Other commenters have mentioned how there are low profit-margins already with health care insurance companies so no company is going to do more than required. The only reason maternity is covered (in states that don’t mandate it) by group plans is a Federal law (ERISA) that requires coverage on group plans offered by employers with more than 15 employees.

    I don’t think Mrs. Kraft’s quote is mutually incompatible. Her point is it shouldn’t cost so much for families to have a baby. Whether that is handled through insurance or lowered health care costs or a combination of the two, that’s all possible.

    If health care providers were able to assist with pregnancy and delivery in a way that gave access to urgent care only if needed at a lower price, that would reduce the pricing for everyone. If insurance companies were charged less, they wouldn’t be so keen on excluding it.

    When there are complications in pregnancy, insurance covers it. The newborn has to be covered from birth without proof of insurability. Why won’t they help to ensure the pregnancy doesn’t have complications and that the baby is born healthy?

    Some folks have mentioned birthing centers as an alternative. Why couldn’t hospitals co-operate one? A birthing center adjacent (next building, next wing, whatever) to a traditional L&D ward. For the normal, no complications, cases, they head over there, midwives or some equivalent assists. If there are any signs of needing urgent care due to emerging complications for mother or child, they’re already very close. To me, this answers the health providers objections that they need to get paid fairly, etc (true) while giving a lower-cost solution to delivery without jeopardizing the availability of urgent care.

  • Matt

    “They should be breaking down the doors of insurance companies making them cover pregnancies. They should be lobbying the medical industry for lowering how much it costs to have a baby.”

    Here’s the problem: those two things are mutually incompatible.

    Either medicine is paid for by third parties, or it’s affordable. You can’t have both. Turning it over to the government just means that you no longer even have the leverage of telling BCBS that you’re going to stop paying them if they don’t get reasonable.

    In prior years, I’d have suggested an HSA and a high-deductible plan…low monthly premiums, you control the costs, and it protects you against catastrophe. You’d certainly have been better off this time around. But those are about to become illegal.

    I just can’t bring myself to understand ObamaCare cheerleaders, knowing that in less than 3 years my wife is going to be forced to choose between her health and her immortal soul, when it becomes a felony to treat her chronic condition with anything except birth control pills.

  • Greg

    2-3% profit that is. That’s super low, insurance companies are not evil. It’s just the media only portrays the negative aspects of then but never the positive help they bring to families every day. Like mine.

  • Greg

    BCBS covered maternity in my state on the individual side until Obama became president. Then with the passage of Obamacare they scaled back on covering pregnancies due to over regulation of government. The more government regulation = more scaled back benefits from BCBS and other companies in order to try and stay in business. Which is only about 2-3%. Relatively low compared to other industries.

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