Supporting Healthy Moms and Babies Act
- Sponsor
- Rep. Golden, Jared F. [D-ME-2]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Jun 5, 2025
Bottom line
The bill aims to eliminate out-of-pocket costs for a broad range of maternal and newborn health services, making them fully covered benefits under most health plans and extending postpartum care coverage to a full year.
What it actually does
This bill expands the definition of essential health benefits under the Affordable Care Act to explicitly include comprehensive prenatal, childbirth, neonatal, perinatal, and postpartum care. Crucially, it prohibits health insurance plans from imposing any cost-sharing requirements, such as deductibles, copayments, or coinsurance, for these services. The bill also extends the definition of the postpartum period to one year after pregnancy ends, ensuring extended coverage for related health services.
Proponents argue
Supporters argue that this legislation will significantly improve maternal and infant health outcomes by removing financial barriers to essential care, thereby encouraging timely and comprehensive utilization of services. They contend it will reduce health disparities, address the ongoing maternal mortality crisis, and provide crucial financial relief to new and expecting parents.
Opponents contend
Critics may contend that mandating zero cost-sharing for these services will inevitably lead to increased health insurance premiums for all enrollees, including those who do not utilize maternal care. They might raise concerns about federal overreach into health insurance markets and the potential for increased healthcare costs without a clear funding mechanism beyond premium increases.
The bill is concise and its core provisions are clearly stated, making it accessible for an informed reader to understand its primary impacts within a short timeframe.
Section 2(a), amending Section 1302(b) of the Patient Protection and Affordable Care Act
Redefining Essential Health Benefits to Include Comprehensive Maternal and Newborn Care
This provision expands the definition of "essential health benefits" under the Affordable Care Act (ACA) to explicitly include comprehensive prenatal, labor and delivery, neonatal, perinatal, and postpartum care and screenings. It specifies services such as ultrasounds, care for spontaneous pregnancy loss, delivery services (including anesthesiology and postpartum health), and non-preventive behavioral health services for conditions exacerbated by pregnancy. It also includes behavioral health services for non-birthing legal parents of a new child for one year.
Supporters argue
Supporters argue this provision ensures comprehensive, high-quality care throughout the maternal and perinatal period, addressing potential gaps in coverage and improving health outcomes for mothers and babies.
Critics contend
Critics might argue that expanding the scope of mandated essential health benefits could lead to increased premium costs for health plans, potentially impacting the affordability of insurance for some consumers or employers.
Tradeoffs
The provision balances the goal of ensuring comprehensive care access with the potential for increased health insurance premiums due to expanded coverage mandates.
Section 3, amending the Public Health Service Act, ERISA, and the Internal Revenue Code
Eliminating Cost-Sharing for Comprehensive Maternal and Newborn Health Care
This section mandates that group health plans and health insurance issuers offering group or individual coverage cannot impose any cost-sharing requirements (such as deductibles, copayments, or coinsurance) for the comprehensive maternal and newborn care benefits described in the expanded Essential Health Benefits. This prohibition applies to plan years beginning on or after the date of enactment, effectively making these services free at the point of care for covered individuals.
Section 2(a)(2)(C), amending Section 1302(b) of the Patient Protection and Affordable Care Act
Extending the Postpartum Period Definition to One Year
This provision explicitly defines the term "postpartum" as the one-year period immediately following the end of a pregnancy. This statutory definition ensures that comprehensive postpartum care, including behavioral health services, must be covered under the Essential Health Benefits and without cost-sharing for a full year, aligning with medical recommendations for extended postpartum support.
These clauses state that the amendments made by the bill shall be considered as if included in the enactment of the Patient Protection and Affordable Care Act (Public Law 111-148).
Section 2(b) and Section 3(d)
Why it matters:This is standard legislative practice to ensure proper integration into existing law, providing a clear legal basis for how the new provisions interact with the established framework of the ACA. It ensures the new mandates leverage the full enforcement and regulatory power of the ACA.
Case for: Proponents would argue this ensures seamless integration with the existing ACA structure, avoiding potential conflicts or ambiguities that might arise if treated as entirely new, separate provisions, and leveraging established regulatory mechanisms.
Case against: Critics might argue that retroactively applying changes to the original ACA framework could be seen as altering the foundational legislative intent without explicit re-evaluation of its original principles.
Estimated impact: Ensures the new mandates are fully integrated into the existing federal health law, subject to its established enforcement and regulatory powers.
This subclause includes "the services required to be covered under section 2725 of the Public Health Service Act, section 711 of the Employee Retirement Income Security Act of 1974, and section 9811 of the Internal Revenue Code of 1986" as part of the new comprehensive maternal and newborn care definition.
Section 2(a)(2)(B)(iv)
Why it matters:This is standard legislative practice to avoid rewriting existing law, but it means a reader needs to consult other legal texts to fully grasp the scope of the mandate. These sections primarily relate to the Women's Health and Cancer Rights Act of 1998, which mandates coverage for mastectomy-related benefits.
Case for: Proponents would argue this ensures that existing, important women's health protections are explicitly integrated and reinforced within the new comprehensive maternal care framework, preventing any potential interpretation that might exclude them from the no-cost-sharing mandate.
Case against: Critics might argue that it adds complexity by requiring external research to fully understand the scope, or that it's a broad inclusion that might not be directly related to all aspects of prenatal, childbirth, neonatal, perinatal, or postpartum care.
Estimated impact: Reinforces existing protections and ensures their inclusion in the new no-cost-sharing mandate for maternal and newborn care.