Obamacare Pregnancies: LEARN FROM MY MISTAKES

Individuals have been emailing me and I’ve been emailing them back one by one and I realize, this is silly! Herewith is a summation of what I have learned so far, and what I wish I’d known before I embarked on my Pregnant On Obamacare journey. If you or someone you love is considering getting pregnant — with or without the support of the ACA — please, feel free to learn from my mistakes and take into account the following:

Nothing is mandatory.

A commenter pointed this out to me yesterday and perhaps it seems obvious to you but it hit me like a cartoon fridge falling on my head and making me see birds.

Medical practitioners tend to assume you want every pre-natal procedure that’s available to you. Because everyone’s over scheduled and over-booked, that means that no one will slow down to go over which procedures are Important To Have, which are Good To Have, and which may simply be Nice To Have, If You Don’t Have To Pay For Them.

Instead, they will default to what I’ve called Lexus Treatment, because why not? It’s all billed to your insurance anyway, and maybe it reduces their risk of being sued.

The calculus changes for the consumer when you have to pay several hundred for each ultrasound. Suddenly, being scheduled for three ultrasounds in your first trimester alone — when experts agree one to two is sufficient for an entire pregnancy— matters a great deal.

You have to push back. It’s up to you and you alone.

Naturally, practitioners themselves like to have as much information as possible. In some cases, that information can be crucial, even life-saving. For example, as a midwife told me yesterday, the glucose test: a pregnant person can have diabetes and not show any symptoms, but if it goes untreated, maternal diabetes can harm the fetus. The glucose test is as close to being mandatory as any pre-natal care is, and yet, you can opt out of that too if you want. Indeed, you can opt out of almost anything. As long as you come in ready to talk about awkward things like money with near-strangers.

Most pre-natal procedures are of limited utility, anyway.

Each test, scan, and peek into your uterus is a Choose Your Own Adventure that offers only two options: the fetus is fine, turn to page 3; or, there’s a chance the fetus is not fine — do you want to abort? Turn to page 51.

If you’re not going to terminate no matter what, all this extra info may not be worth paying for. Even if you would consider termination, be aware that what you’re going to get from these tests, most of the time, is the knowledge that the fetus has an increased risk of an abnormality. There’s very little certainty going around.

Obamacare isn’t to blame.

A fellow wrote me from Louisiana asking whether I thought the dysfunction I was experiencing was a result of my getting health coverage from the exchanges. Actually, I was able to tell him, I’ve only had good experiences with my Oscar insurance so far. The letters they’ve sent explaining what costs I’m responsible for have been models of conciseness and clarity. They’ve been covering more of the costs than I expected them to. Reps have even called me to see if I have questions or want to talk to their experts.

Besides, I was put on the same assembly line with my first, pre-Obamacare pregnancy. Until I switched to the midwives, the communication was far worse and I had even less of a sense of what was being done to me and why.

The difference now is that, because I have a high-deductible plan, I’m able to pay more attention to — and get more outraged about — the fact that pregnant folks are treated by our health care system in ways that are unnecessary, and unnecessarily expensive.

If you’re planning to get pregnant on a high-deductible plan, set up and fund a pre-tax HSA in advance.

Thanks to commenter/contributor Elise Nussbaum for that tip.

Get educated about what you’re entitled to.

A CPA from Wisconsin sent me a message saying the following:

What a shame. As soon as a women learns she is pregnant she has a Special Enrollment Period (SEP) under PPACA. You could have changed your plan to a low deductible gold or even platinum plan. Because you and/or your husband are self employed you can deduct 100% of the health insurance premium. It is almost impossible to deduct co pays.
If you were a low income women your pregnancy adds an additional person to the calculation for either the health insurance income tax subsidy or possible Medicaid coverage.
We need to get this message out to all child bearing age women.

I agree! It’s too late for me but, friends, it might not be too late for you.

Edited to add info from an email I just received:

Hi Ester, you said in your post that pregnancy can trigger a special enrollment period. Unfortunately, that’s not actually the case. The birth of a child will. It’s crappy and something that people are trying to change, but that’s what we get for not living in Scandinavia.