The Oregon Department of Consumer & Business Services has scuttled an idea to open enrollment for women who get pregnant outside the three-month window when consumers can buy individual health insurance, after discovering that technical shortcomings of the federal enrollment website will not allow the state to offer such an option.
A special enrollment period may have been a heavy lift for state regulators due to the insurance industry’s opposition, but the technological complication forced them to punt the discussion into the future anyway. “There may be flexibility in the future for customization,” with healthcare.gov, said Joel Metlen, spokesman for the Oregon Health Insurance Marketplace.
The roadblock adds intrigue to the state’s current consideration of switching from the federal website to a platform based on another state’s exchange, although Oregon marketplace spokesman Joel Metlen said cost, viability and market disruption would still be the primary factors that state functionaries will consider when deciding on a recommendation to legislators. A state-based website would likely be more customizable.
The Oregon Health Insurance Marketplace officials are currently analyzing four separate options for buying into another state’s website technology, and plan to report either their preference for one of the four or maintaining the federal website next month, after the May 17 primary election.
“It’s limiting our innovation and our ability to enact policies that best serve Oregonians in accessing affordable healthcare,” lamented Hannah Rosenau, the director of policy and quality improvement at the Oregon Foundation for Reproductive Health, which agitated for allowing women to purchase health insurance at any time of the year if they are pregnant, a policy that’s been adopted by New York state, which still has its own enrollment website.
Because of the risks associated to childbirth with a lack of coverage for prenatal care, the overall healthcare system could save on costs by investing in the health of these women, costs which Rosenau earlier told The Lund Report averaged $2,800 per baby.
Insurers fought the proposal at earlier meetings of the Healthcare Reform Rulemaking Advisory Committee, referring to women who go without insurance as “lawbreakers” who do not deserve special treatment from state policymakers.
The Affordable Care Act limits the period when individuals can buy health insurance from November through January so that people do not wait until they get sick, injured (or pregnant) to buy insurance, a concession that Congress gave to the insurance industry to mitigate risk.
The newly enacted premium assistance program that covers the premiums and out-of-pocket expenses of low-income Pacific Islanders who do not qualify for Medicaid also does not conform with the limited technological options of healthcare.gov, but Metlen explained that the state was able to get around that by allowing them to choose a plan on the website and then work with state functionaries to link consumers manually with state aid to cover the cost of their health coverage.
But Metlen said the pull-down menus on healthcare.gov don’t even offer an exception for pregnancy from February through October -- the months when enrollment is closed. Insurance can still be purchased at that time if a person moves, loses a job, loses Medicaid coverage or at a child’s birth, but not its conception. “They can’t handle any additional functionality,” he said.
Since 95 percent of Oregonians are now covered either by insurance, the Oregon Health Plan, or Medicare, the special enrollment period would be necessary only to a small fraction of would-be mothers. The Oregon Health Plan also covers pregnant women at a higher income level than the regular population -- 185 percent of poverty as opposed to 138 percent.
Undocumented immigrant women can receive Medicaid if their income is low, because their child will be an American citizen, due to a Bush-era quirk in federal law that provides the coverage to the fetus rather than the mother. But for citizens who do not qualify for Medicaid, the insurance market offers no such fetus-based coverage.
Besides offering them access to private insurance, Oregon does have other options to getting the remaining uninsured pregnant women covered. California supplies Medicaid to women up to 322 percent of poverty, although women at the top of that income scale pay a small premium. Iowa offers Medicaid to pregnant women up to 375 percent of poverty -- nearly the same level that such women would be eligible for subsidized insurance on the insurance exchange.
