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Pregnancy, the Federally Facilitated Marketplace, and Special Enrollment Periods

May 11, 2015

A Call to Action for National Women’s Health Week

By Emily A. Eckert, Community Health Organizer

Today marks the kickoff of a weeklong, nationwide celebration of advancements in women’s health throughout the ages. National Women’s Health Week is an observance led by the U.S. Department of Health and Human Services Office on Women’s Health. 2015 is the 16th annual celebration, encouraging women everywhere to take control of their health. 

The Pennsylvania Health Access Network (PHAN) is celebrating National Women’s Heath Week by issuing a three-part educational blog series focusing on three key issues: pregnancy, the Federally Facilitated Marketplace, and Special Enrollment Periods; how women can protect their right to free preventative care, including birth control; and how the new HealthChoices Medicaid program is helping women in Pennsylvania. 

Since the passage of the Affordable Care Act (ACA), an estimated 17 million women have gained access to care. After Pennsylvania expanded Medicaid eligibility on December 1, 2014, an additional 179,000 Pennsylvania women became eligible for affordable, high-quality health insurance. 

Though women have gained a number of benefits under the ACA—including preventive services such as mammograms and cervical cancer screenings without a copay—there are still many gains to be made. One area that needs improvement is the recognition of pregnancy as a qualifying life event.  

Qualifying life events are changes in your life that make you eligible for a Special Enrollment Period (SEP) outside of the traditional open enrollment period for the Federally Facilitated Marketplace (FFM). One qualifying life event that is particularly relevant to women is the birth or adoption of a child. If you or a family member experience the birth or adoption of a child throughout the year, it is your right to apply for health care coverage on the Marketplace so long as you meet the other eligibility requirements. Pregnancy, however, is not currently considered a qualifying life event by the federal government.

Making sure that pregnant women have access to affordable, comprehensive health care is an important priority at PHAN. Studies have shown that early access to pregnancy-related health services are vital for healthy pregnancies, healthy mothers, and healthy babies. Appropriately, finding out that you are expecting a child should be a government-recognized life-changing event. While a number of women are able to enroll in Medicaid or the Children’s Health Insurance Program (CHIP), not all women have access to or are eligible for these resources. If a woman residing in Pennsylvania earns above 185% of the Federal Poverty Level (FPL) and finds out she is pregnant after the Open Enrollment Period, she will likely not have access to coverage. 

Advocacy organizations throughout the country have been fighting hard for pregnancy to be included as a qualifying life event. In early March the federal legislature got involved, as Pennsylvania Senator Bob Casey and thirty-six other senators wrote to DHS Secretary Sylvia Burwell to request that she “create a special enrollment period to maximize women’s access to coverage.” Only days later, fifty-four members of the House of Representatives signed a similar letter addressed to the Secretary.

To date, Secretary Burwell has not allowed a special enrollment period for pregnancies. She has, however, ruled that states with state-based health insurance exchanges could set up SEPs for pregnancy if they so choose. This decision gives great power to states that run their own marketplaces, like New York and California. For states that partner with the Federally Facilitated Marketplace, it is our job to continue advocating for pregnancy to be recognized as a qualifying life event.

According to the Guttmacher Institute, 41-47% of pregnancies in Pennsylvania are unplanned. With a percentage that high, it is critical for our state leaders to step-up and fight for expanded access to care for women caught in this often-unexpected situation.  

For the 16th annual National Women’s Health Week, PHAN encourages all women to take control of their care. We also invite all advocates to work toward defining pregnancy as a qualifying life event so that no pregnant woman is left without access to care. Though women have gained a number of benefits under the Affordable Care Act—including special enrollment periods after giving birth or adopting a child—it is vital that these protections be extended to expectant mothers before they give birth. 

If you are interested in getting involved in this issue, please contact PHAN for additional information and ways to get involved.


Emily A. Eckert is a Community Health Organizer and Certified Navigator at the Pennsylvania Health Access Network.