Lives of women and babies hinge on healthcare package
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The Affordable Care Act, also known as ObamaCare, ensured access to healthcare for millions of women and their children, including those in need of high-risk pregnancy specialists and services. The Society for Maternal-Fetal Medicine (high-risk pregnancy physician specialists) recently issued a plea to Congress to make sure that any health care replacement package for the ACA includes essential health care services for pregnant women and their babies.

The U.S. has one of the worst infant and maternal mortality rates among wealthy countries. Adverse pregnancy outcomes not only affect the baby in terms of physical and developmental disabilities, but are also a large financial burden due to costs of neonatal ICU hospitalizations and long-term specialty care. In addition, abnormal pregnancies can often produce poor outcomes for the mother in terms of chronic illness, hospital stays, severe morbidity and even death. These medical and financial burdens can be addressed, in part, by continued and improved access to care before, during, and after pregnancy.


Our nation’s leaders—in the White House, in Congress and in State capitols—must protect and improve women and infant health coverage, regardless of its source, guided by the following principles:


1) All women who may become or are pregnant must have health coverage that provides all medically necessary, situation-appropriate benefits that promote healthy pregnancies and child development.

These benefits must include access to prenatal and postpartum care visits equivalent to those outlined in ACOG’s Guidelines for Perinatal Care, and access to subspecialists and specialized interventions for those with high-risk pregnancies that aim to prevent lifelong childhood disabilities and decrease future financial burden.

Benefits covered must include preconception, prenatal, labor and postpartum care, including mental health services, prenatal diagnosis, nutrition counseling, lactation support, contraception for pregnancy spacing; as well as appropriate services, supplies, devices, and prescription medications for those women with high-risk pregnancies, without arbitrary limits.

2) All women who may become or are pregnant must have coverage that is affordable for their families. Regardless of income or health status, these women and their infants must be able to get the care they need without jeopardizing their families’ financial security. Out-of-pocket limits on premiums, deductibles and cost-sharing similar to those under Medicaid and CHIP should be established for private coverage so that pregnant women – including those with the most complex conditions – can afford appropriate and timely healthcare.

This care should not be restricted to a predetermined number of visits, but rather based on the acuity of the medical condition. Providing this necessary coverage can help avoid the danger of future medical disability and spiraling financial cost when this coverage is denied or unaffordable.

3) All women who may become or are pregnant must have access to the full range of appropriate health care providers, including perinatal specialists, subspecialists and facilities throughout their pregnancies.

All public and private health insurance should ensure that pregnant women do not lose access to their current providers during their pregnancy, that they are able to see the type of provider depending upon their personal healthcare needs, and that such providers are not “cut off” due to network changes during pregnancy. Coverage for services should not depend on whether the treatment, test or intervention is aimed at the baby versus the mother. A healthy mother is essential to have a healthy outcome for the baby.

4) All women who are or may become pregnant must have continuous, consistent coverage with no gaps in care. All public and private health insurance should not lapse during pregnancy due to changes in network requirements, change in services covered, change in calendar year, etc. Changes in coverage and access during the time of pregnancy creates detrimental gaps in care for women.

Passage of ACA ensured access to this care for millions of women and their children. Rolling back these essential services will result in millions of women losing their coverage. Health insurance status has long been linked to better access to doctors, hospitals, medications and ultimately improved health outcomes.

Repealing the ACA without ensuring essential healthcare services to pregnant women will substantially negatively impact maternal and child healthcare in the United States. Doing so would roll back current strides in family health. SMFM members urge Congress to continue to ensure access and coverage for preconception, prenatal, labor, delivery, and postpartum care. SMFM stands ready to provide medical expertise and advice in developing the next phase in our health care system.

Alfred Abuhamad, M.D. is professor and chairman of Eastern Virginia Medical School’s department of obstetrics and gynecology, in Norfolk, Va. He is also vice dean for clinical affairs, and the president of the Society for Maternal-Fetal Medicine. He is known internationally for his work in high-risk pregnancy, ultrasound, global health and safety in women’s healthcare.

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