Why C-section as a Pre-existing Condition Matters More Than Ever

This month’s Kaiser Health Tracking Poll showed that the majority of Americans are concerned about protections for people with pre-existing conditions. Half of Republicans polled would not support the Supreme Court in overturning these protections.

These results echo their June tracking poll, in which a majority stated that it is “very important” these protections remain.”

Kaiser Family Foundation reported that as of January 2010, just prior to the Affordable Care Act being signed into law on March 23, 2010, only 18 states mandated maternity coverage in the individual or small group markets. This problem was eliminated by the ACA’s mandate that these plans must provide maternity care coverage.

When the American Health Care Act of 2017 (H.R. 1628) listed C-section-- and pregnancy itself-- as pre-existing condition, medical societies and the women’s health organizations who had fought discriminatory insurance practices in the years before the ACA passed were quick to voice dissent last May. While the AHCA protected access to coverage, it didn’t include language that capped how much extra people with pre-existing conditions can be charged.

Last month, the current administration told a federal court that it would no longer defend provisions of the ACA that protect consumers with pre-existing conditions.

Why does C-section as a pre-existing condition matter so much?

Besides being considered discriminatory to penalize someone for their previous mode of delivery, the magnitude of the problem has changed in recent years. Pregnancy and childbirth account for about 23 percent of all hospitalizations.

What has shifted is that the number of women with a history of a cesarean birth who give birth annually has increased threefold since 1980 and 50 percent since 1995.

Two decades ago, around 400,000 gave birth (whether vaginally or by cesarean) each year with a prior cesarean, compared to about 600,000 now. 

Number of Patients with a Cesarean History, [Total Births], Percent of All Births

1980: 184,000*   [3,612,258]    5.1%

1995: 408,869    [3,899,589]   10.5%

2003: 486,301    [4,089,950]   11.9%

2016: 601,788     [3,945,875]    15.3%

*estimate

The overall and “low-risk,” or NTSV, cesarean rates both peaked in 2009.

Ten years ago this summer, Peggy Robertson of Colorado was on the front page of the New York Times with her story of being denied insurance by one company because she had previously given birth by cesarean. She testified before the Senate Committee on Health, Education, Labor and Pensions in 2009 after working with patient advocates from the International Cesarean Awareness Network.

Four million babies are born every year and approximately 600,000 of those are to women with a previous cesarean. In light of recent efforts to combat the country's high maternal mortality and morbidity rates, which are the highest of any developed nation, we need to commit to adding protections for pregnant people instead of taking them away.