BILL NUMBER:S4639A

TITLE OF BILL:

An act to amend the insurance 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 section 3114 to the insurance 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 date of health plan coverage is
effective on the date of the application.

Section two 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
Marketplace, as established under the federal Affordable Care Act.
New Yorkers may enroll in health plans during a designated open
enrollment period, 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 preeclampsia, 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.