Connecticut legislature passes bill to let pregnant women enroll during off-season

A few years ago, New York State passed a law which allows uninsured pregnant women to enroll in ACA exchange coverage outside of the official Open Enrollment Period. Here's what Louise Norris and I wrote about it at the time:

On another note, I also want to use this as an opportunity to point out that maintaining quality health insurance coverage needs to be a priority year in and year out. Jenks notes that "Pregnancies are often unplanned, making limited enrollment periods impractical for many women." But can't that be said of any medical condition? In fact, I would say pregnancy is one aspect of healthcare that's probably much more likely to actually be planned. While about half of pregnancies are planned, I doubt the same could be said for cancers, heart attacks, or car accidents.

In other words, while not all pregnancies are planned, overall it's a lot less "random" than most other expensive healthcare incidents.

Is there a line which needs to be drawn? Of course. Is pregnancy that line (again, assuming it's not caused by rape/incest)? Perhaps. Is domestic violence well within that line? In my opinion, absolutely.

(This was actually in a post about New York joining HealthCare.Gov in making being a domestic violence victim a Qualifying Life Event (QLE) for off-season enrollment as well.)

In other words, I have mixed feelings about adding pregnancy to the Qualifying Life Event list.

To be honest, I was surprised to learn that California hasn't done the same thing, but apparently they only allow a Special Enrollment Period (SEP) for pregnant women if their primary care physician leaves their network during the pregnancy. Huh.

In any event, Connecticut is apparently on the verge of becoming the second state to include pregnancy on the QLE list:

Connecticut lawmakers overwhelmingly passed bill to make pregnancy a qualifying event in the indiv market:
Gov Malloy has until early June to sign it (as long as he doesn't veto, it will take effect).
Effective date: Jan. 2019 @EyeOnInsurance @charles_gaba

— Louise Norris (@LouiseNorris) May 24, 2018

There are some caveats, however:

The legislation only applies to the ACA-compliant individual market, and only applies to women who don't already have minimum essential coverage. So it wouldn't allow a woman to upgrade her coverage when she finds out she's pregnant.

— Louise Norris (@LouiseNorris) May 24, 2018

Norris gives more detail here:

The birth of a baby is considered a qualifying event under federal rules, but a pregnancy is not. HHS considered the possibility of changing this a few years ago, but clarified in 2015 that they had decided against making pregnancy a qualifying event.

That's noteworthy, and shows just how tough a call this is: The Obama Administration decided to give a thumbs down to making pregnancy a QLE.

But in New York, legislation took effect in 2016 that makes pregnancy a qualifying event. And Connecticut is poised to do the same thing, starting in 2019. S.B.206 passed 139-10 in the Connecticut House, and 35-0 in the Senate during the 2018 session. It calls for a special enrollment period that lasts for 30 days from the time a woman’s pregnancy is confirmed by a licensed health care provider. The special enrollment period would only apply to ACA-compliant individual market plans, and would only be available for women who do not already have minimum essential coverage. So it would not allow a pregnant woman to switch from, say, a bronze plan to a gold plan when she finds out she’s pregnant.

The bill was sent to Governor Malloy on May 18, and the Connecticut Senate’s office said that Malloy is likely to sign the legislation by the end of May (they do not anticipate any objection, given the overwhelming support the bill had during the legislative session, but Malloy has previously expressed concerns about a pregnancy-related special enrollment period).

...Assuming Malloy signs the bill or it takes effect without his signature, pregnancy will become a qualifying event in Connecticut’s individual insurance market, effective January 2019.

Again, I'm torn about this. As Norris noted, the whole point of having health insurance in the first place is because you never know what might happen...and the whole point of having a limited time window for enrolling is specifically to prevent people from gaming the system by avoiding paying premiums for long stretches of time and then only signing up the moment they realize they're gonna need expensive medical treatment. This is standard practice when it comes to making changes in most employer-sponsored insurance policies, as well as for making changes to your Medicare plan.

Furthermore, now that the individual mandate has been repealed, the Open Enrollment Period is pretty much the only "negative" incentive left for people to enroll at all (besides the cost of the premiums themselves, of course). If you remove that as well, the last section of the Red Leg of the 3-Legged Stool is completely gone.

On the other hand, as Gov. Malloy noted, these are desperate times:

“We have in the past expressed concern with this legislation’s potential to drive up premiums — particularly its impact on plans purchased through Access Health CT — but we will give the bill a careful review,” Malloy spokesman Leigh Appleby said after the House’s vote on Tuesday.

“The best way to ensure that women have access to prenatal care is to make sure people maintain continuous health insurance coverage,” Appleby said. “However, national Republicans’ repeal of key components of the Affordable Care Act, including the individual mandate, has had a destabilizing effect on the individual market and has made it necessary for legislators to consider half measures like this.”

Put another way, the GOP amputated 2/3 of the Red Leg, so we have no choice but to start whittling away at the remaining third.