NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A6780B
SPONSOR: Simotas (MS) TITLE OF BILL: An act to amend the insurance law and the public
health law, in relation to permitting pregnant women to enroll in the
state health insurance exchange at any time
PURPOSE OR GENERAL IDEA OF BILL:
To add pregnancy to the series of qualifying events that trigger a
special enrollment period for the state health insurance exchange so
that pregnant individuals can enroll in a health plan through the
exchange at any time.
SUMMARY OF SPECIFIC PROVISIONS:
Section one adds a new subsection (d) :to section 3217-c to the insur-
ance law to provide that pregnancy shall be an event that triggers a
special enrollment period available to individuals for enrollment at any
time in a qualified health plan in the state health insurance exchange.
This section also provides that the first day of the month in which a
woman is certified as pregnant by her doctor.
Section two adds a new section 2507 to the public health law to provide
the same provisions.
Section three provides the effective date.
JUSTIFICATION:
Eligible New Yorkers may enroll in qualified health plans through the
state's health insurance exchange, the New York State of Health Market-
place, as established under the federal Affordable Care Act. New York-
ers may enroll in health plans during a designated open enrollment peri-
od, and during a special enrollment period if they experience a
qualifying event. Qualifying events that trigger a special enrollment
period include marriage, divorce, gaining citizenship, and birth, among
others. This bill adds pregnancy to the list of qualifying events for a
special enrollment period. This will' enable pregnant individuals, who
are otherwise eligible for exchange 'plans) to enroll in a health plan
at any time.
Women who become pregnant and who have income below 223% of the Federal
Poverty Level may already enroll in Medicaid at any time of year in New
York State. However, if a woman's income is over this limit and she does
not have employer-sponsored health care, she may face high out-of-pocket
costs to secure prenatal and maternity care, or even worse, go without
care. This bill allows women who are not eligible for Medicaid and who
become pregnant outside of the exchange's open enrollment period to
apply for a qualified health plan.
The New York City Comptroller recently released a report that examined
this issue and highlighted the health benefits of prenatal care for
pregnant women and newborns, and the potential long-term cost savings of
prenatal care to the state's health care system.* Babies born to mothers
who received no prenatal care are three times more likely to be born at
low birth weight, and five times more likely to die, than those whose
mothers received prenatal care.** Diseases that pose health risks to
pregnant women can be mitigated by maternity care, including preeclamp-
sia, placental abruption, diabetes, heart conditions, and Graves'
disease.*** Further, a study in the Journal of the American Board of
Family Medicine found that prenatal care for teen mothers would save
between $2,369 and $3,242 per pregnancy.****
Several states have already expanded the number of qualifying events for
special enrollment periods on their state health exchanges, Pregnancy is
a significant, life-changing event and should be added to New York
State's list of qualifying events for health exchange coverage. This
bill will promote the health and well-being of pregnant women and their
newborns, and ensure better health outcomes for this population.
FISCAL IMPLICATION:
None to the state.
EFFECTIVE DATE:
January 1, 2016
* Office of the New York City Comptroller Scott M. Stringer, "Time to
Deliver: Pregnancy and the Affordable Care Act," March 2015.
** US Department of Health & Human Services,
http://mchb.hrsa.gov/programs/womeninfants/prenatal.html.
*** Postolowski, C., Young Invincibles. "Without Maternity Coverage:
The Need for Special Enrollment in the Health Insurance Marketplaces
during Pregnancy." December 2014.
**** Hueston, W., et al. "How Much Money Can Early Prenatal Care for
Teen Pregnancies Save?: A Cost-Benefit Analysis." J Am Board Fam Med
May-June 2008.
