Bills approved mandating ‘essential benefits,’ helping uninsured pregnant women

A bill headed to Gov. Dannel P. Malloy’s desk would give uninsured women the ability to sign up for health insurance after they learn they are pregnant.

The bill would make pregnancy a “qualifying life event,” like the birth of a child or a job loss, so expectant mothers could enroll in individual health insurance plans outside of the yearly open enrollment period.

The House gave final approval to the bill on Tuesday by a vote of 139 to 10. The Senate unanimously approved the measure on May 2.

“We fought three hard years to get the bill to where it is today,” said Sen. Kevin Kelly, R-Stratford, the Senate Republican chair of the Insurance and Real Estate Committee and a sponsor of the bill. “It’s been a long process … I’m very excited that we’ve been able to accomplish this.”

Kelly said that, under the bill, a special enrollment period would be offered for 30 days after a pregnancy is confirmed by a licensed health care provider.

During a two-hour debate on Tuesday, House members repeatedly questioned whether the wording of the bill meant the 30-day time period began at conception or when a doctor had confirmed the pregnancy.

Rep. Rob Sampson, R-Wolcott, ranking member on the insurance committee, voted against the measure.

“I feel like we are carving out an exception that we would not do for someone else who gets sick suddenly, or has some other reason that they might have a sudden need for insurance,” Sampson said.

Malloy also has had concerns.

“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.”

Under federal law, individuals cannot purchase insurance outside of the yearly open enrollment period unless they experience a qualifying life event. Pregnancy is not currently classified as a qualifying life event in Connecticut.

The bill does not apply to group health insurance plans.

Bill mandates 10 essential benefits

A second bill sent to Malloy requires individual and small-group health insurance policies to cover the same 10 “essential health benefits” the Affordable Care Act mandates. The legislation would ensure that even if the federal health care law changes, insured Connecticut residents will maintain these benefits.

The Senate passed the “essential benefits” bill 34 to 2. The dissenting votes came from GOP Sens. John Kissel of Enfield and Joe Markley of Southington. The House approved the measure on April 26, 114 to 32.

“Essential health benefits” are health care services and benefits that fall within the following categories:

• ambulatory patient services
• emergency services
• hospitalization
• maternity and newborn health care;
• mental health and substance use disorder services, including behavioral health treatment
• prescription drugs
• rehabilitative and habilitative services and devices
• laboratory services
• preventive and wellness services and chronic disease management
• pediatric services, including oral and vision care.

The 10 essential-benefits mandate applies to individual and small employer group health insurance policies.

The bill also requires insurance companies to cover a 12-month supply of birth control.