Why are some middle-class women denied health insurance coverage if they had C-Sections?

Interestingly, Congress has been listening to women testify that they have had C-sections and have been denied health insurance because they will not undergo sterilizations. See the article, "After Caesareans, Some See Higher Insurance Cost – NYTimes.com." See the uTube video, "Peggy Robertson tells her story of insurance denial."

According to the NY Times article, "Some insurance companies exempt women from raising the rates of insurance if they get sterilized." The reason why is that it cost more to have a Caesarean section (C-Section) than to have a natural birth. There’s the added risk that the scar from the former C-section in the uterus might open up during labor or birth.

Recently, Sen. Barbara Mikulski (D-MD) thought it morally repugnant and offensive that some private insurers would demand sterilization of females that had applied for individual health insurance, according to the Oct. 16, 2009 Examiner.com article, "Women Told to Get Sterilized or No Health Insurance. Also see the McClatchy media article, "Health insurance company won’t sell woman coverage unless she gets herself sterilized."

Mikulski is a senior member of the Health, Education, Labor and Pensions (HELP) Committee which produced one of the major health care reform bills. Why should some middle-class women or any woman of any class be told to get sterilized in order to get health insurance coverage? And why should coverage be denied for healthy women just for having a baby?

Is it the old line now applied to humans that veterinarians tell dog-handlers, "If you can’t afford the healthcare for your dog, don’t get a dog?" To put it lightly, the Senator wasn’t amused by the idea of some insurers denying health care coverage for childbearing. For us consumers, the thought is, in the future, will all insurers take this attitude?

Insurer’s rules on prior C-sections vary with each company and by state, because the various states regulate insurers. There are 160 million Americans that have health insurance plans through their employers or their spouse’s employers. But as more people become self-employed, take jobs without health insurance, work part time, return to college, or lose their jobs, the need for individual insurance policies will be increasing in the foreseeable future.

It’s going to be tough for women that have to get health insurance on their own without an employer’s financial help. If you’re denied health insurance because you refuse to get sterilized after your last C-section where can you turn for help? First you need to find out whether your state offers health insurance coverage to people denied health insurance by private insurers. Premiums are very high.

But if you’re a woman denied private insurance because you previously had a C-section, you can find out whether your state offers insurance and how much it costs. Some private insurance companies that used to exclude C-sections now cover them, but are charging you an increase in costs as you pay your premiums. Can you afford the increase?

In order to get health insurance, some women are getting sterilized–having their tubes tied for the purpose of removing the insurance risk. In some cases women that had been denied health insurance previously are getting health insurance once they get sterilized. But the ethical question remains, why should you have to tie your tubes in order to get health coverage? Insurers look at the sterilization as removing the risk of further C-sections or the risk of having a natural birth with the added risk of a ruptured uterus as a complication from a previous C-section.

Other insurers want women to wait five years after a pregnancy without a complication if they’ve had a previous C-section in order to get coverage and remove the risk. What angers a lot of women is that they wonder why some insurers tell them to get sterilized in order to get covered by health insurance. A C-section is not really a pre-existing condition, but some insurers use the fact that a pre-existing condition might have led to the first C-section, such as getting diabetes while pregnant or high blood pressure.

Insurers also sometimes worry that doctors are scheduling C-sections when it’s convenient for them or to avoid a long labor if a woman asks for a C-section to avoid labor. Another big worry for the women is the problem that once you’re denied insurance, who else is going to give you insurance? For further information, see the June 1, 2008, NY Times article, "After Caesareans, Some See Higher Insurance Costs."

Also see this more recent article, " Women told to ‘get sterilized‘ or no health insurance‎," October 16, 2009. Isn’t it amazing that Congress just learned that women who have had Cesarean sections have been denied health insurance unless they agree to sterilization? This problem has been going on for a long time before it even reached Congress. Of interest also is the article, "Discrimination Against Middle Class American Women « The Urban Grind."

Let’s say you’re in perfect health. You have a C-section. You’re then denied health insurance unless you get sterilized or pay much higher premiums because of the risk of what might happen if you get pregnant again.

It’s the middle-class mom told to get sterilized or lose health insurance, or find state insurance if it exists, or find individual insurance and pay enormous premiums she can’t afford now that she has a newborn to care for at home. If you’re a woman who doesn’t want to pay to put your infant in daycare so you can work to pay for your premiums you can’t get from employers, what can you do?

It’s not the poor woman on Medicaid that’s being denied. It’s the middle-class mom, and no one has brought this to the attention of Congress until now. See the article, "Being denied health insurance coverage for maternity care." Also see the articles, "Insurance Companies: Get Sterilized and Then We’ll Cover You," and the article, "Another reason to avoid a C-section « Woman to Woman Childbirth." Also see: "Info On C-Sections – NYC Doula Service." Insurance companies want you to get sterilized if you’re going to have repeat C-sections like a lot of the celebrities you read about in the media.

According to a May 27, 2009 Reuters Health report, " Full-term neonates delivered through elective repeat caesarean have higher rates of respiratory morbidity, hypoglycemia, and admission to a neonatal intensive care unit (NICU) than infants delivered by vaginal birth after a previous cesarean, investigators in Denver report in the June issue of Obstetrics & Gynecology." That’s one of the reasons why you could be dropped from health coverage or asked to be sterilized, or in some cases, pay a lot higher premiums.

If that’s what is happening to middle-class women with incomes or spouses with incomes, think what will be happening to poor women on Medicaid in the near future. What do you think is a solution to this risk situation? Should people go back to zero population growth as it per the 1965 media (two children to replace you and spouse) or find out whether your state will give you health coverage if you’re denied by private insurers? Or find a private insurer who doesn’t exclude C-sections that you didn’t plan to have just for time convenience–that you really needed?

For further information, see the HELP Committee site at Senator Mikulski’s website, "Health, Education, Labor and Pensions Committee (HELP)."