A Pregnancy Story: Before and After ACA

“The Democrats continue to take more freedom away,” McCarthy said. “This bill provides more freedom to the individual, more choice and more opportunity.”

House Majority Leader Kevin McCarthy

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Many House Republicans are admitting that they did not read the ACA repeal bill before voting. Maybe that’s why McCarthy’s words are so out of touch with reality.

I read these words after the US House of Representatives voted to repeal some major parts of the Affordable Care Act on May 4, 2017. Rep. McCarthy’s use of the words “freedom” and “choice” actually soured my stomach. These were that last things a poor pregnant woman experienced before the ACA evened the care playing field and made services available to all Americans, regardless of economic status.

The bill goes to the Senate next. I hope they can consider my story and others like mine before voting.

I had a baby in 2003, before ACA was enacted and my last child was born in 2015, under the ACA’s flawed but protective umbrella. Trust me, the difference was like giving birth in two different countries and freedom was the last word that I would use to describe what happened.

2003 and Pregnant

I was 23 and pregnant. We had no insurance. My husband was working two jobs that offered crappy and expensive coverage. We needed that money for bills and food. I was trying to finish my degree while parenting our other three kids. After a quick run of the numbers, hubs and I decided that we would have no choice but to sign up for the state-run Medicaid.

We lived in a poor rural area of Arkansas where the WIC checks were distributed out of the county health departments as were the vaccinations and healthcare applications. I got prenatal vitamins there and some booster shots I had missed over the years. This is the last time I would get medical care for my pregnancy. The next time would be in three months and the beginning of my second trimester.

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I never knew that the hospital in the town I delivered in was a teaching hospital until I was pregnant. My obstetrician of record was but a name on a form. I never saw him. Ever. Furthermore, I never saw any of the doctors at hospital’s clinic more than once. Each visit, there was a new face inquiring about my ankle-swelling and water intake.

The most problematic about never seeing the same doctor for each prenatal appointment is the lack of consistency. I had to repeat the same concerns each time, oftentimes because a promise to address them by one doctor was never communicated to the next. I’d go to one appointment to hear that my iron was low and that I was at risk for anemia. They would retest and keep an eye on it at the next appointment. Then, at the very next appointment, the doctor would have no knowledge of the need to test or the low result! At a later appointment, after complaining of weakness and dizzy spells, my doctor would admonish me for not taking prescribed iron supplements ordered by a previous doctor a few appointments back — orders I never received.

Such care had me questioning the true health of my baby and the competency of the people who were supposed to be helping me. However, I had no choice but to go to the clinic for care. Medicaid would not cover any other doctor and any other facility. I was stuck. Freedom was the last thing from my mind. In fact, I felt trapped in a government-spun web.

The mistrust was accompanied by the feeling of being less than a human to the people “caring” for me. The nurses were great, but the many doctors I saw seemed to only be interested in me if I exhibited an extraordinary health issue. A healthy pregnancy was dull. They needed something to study. Even after the birth of my son, I felt as if I were just another woman on the birthing assembly line. There was no aftercare, aside from a doctor’s visit six weeks after the birth.

Everyone was in a hurry to get us out. The pediatrician who examined my son completely dismissed my concerns that the baby’s skin tone was an odd yellow hue. He told me that it was his melanin coming in. As a black mom having her fourth baby, I knew this sounded odd. But, he was gone before I could say anything else.

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A newborn with jaundice under the bilirubin lights.

A week later, we rushed my newborn to the ER where he was diagnosed with jaundice and spent several days in hospital crib under bilirubin lights with IV lines running through him. Our Medicaid appointed pediatrician complained about the once-over we were given in the hospital, but that was the end of it. We were too poor to do anything but be grateful Medicaid was picking up the bill for the baby’s hospital stay. We were too afraid to rock the boat by filing a complaint or suing.

Anyway, I had enough on my hands. Not long after the jaundice issue, I would develop postpartum depression. Of course, we didn’t know what it was. I stopped sleeping for four days and probably endangered our kids at the time. None of my OB doctors ever knew or cared about this. I was just another pregnancy stat on the state’s logs.

Key Changes in the Pregnancy Coverage

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Some of the key changes on the coverage when the ACA regulations took over were created to ensure that women could access quality healthcare no matter what their financial status was. Before, the Medicaid coverage depended on the states, and many were inadequate. There were barriers to receiving care such as the referral system that only allowed women limited choice of doctors or clinics for care. Some required special qualifications for procedures outside the normal pregnancy requirements. Most states limited coverage after the pregnancy to 60 days, with no regard to the PPD window.

The insurance world was no better. Insurance companies were also allowed to deny coverage due to paperwork mishaps, to women who did not report their pregnancy in the timeframe the insurance company decided on. There were also barriers such as referrals, special payment scales and arrangements, and also limitations on the care the mothers and their babies would receive.

You can see more here:

Q&A on Pregnant Women Coverage under Medicaid and ACA

How the Affordable Care Act (ACA) Affects Pregnant Women and Families

2015 and Pregnant

I was 35 and pregnant. This time, I was working part-time and my husband working full-time. We had insurance through ACA. I would call my OB the next day to set up an appointment to confirm. My next appointment was a few weeks later with an ultrasound days later to date the pregnancy. I walked into both appointments without paying a copay or filling out paperwork. “We just have to send your insurance company proof of pregnancy and your pregnancy care kicks in,” was what the receptionist told me. We later got a letter stating what our estimated responsibility would be, which was essentially the deductible. The insurance would cover the rest. I was given a choice of several doctors within a few miles of town. I chose one close, who took over my old gyno’s practice.

Every visit, I saw the same doctor and nurse. There were no substitutions and shakeups. After the tests, checks, etc. are done, my doctor always talked with me about how I was feeling, the pregnancy, etc. The student joined in. I was not just a body to anyone there.

The chats always started with how I was feeling and were about stress and relief. The doctor knew about my ADHD and previous bout with postpartum depression in 2003. I told her about both in our initial interview. Once that stuff was out of the way, we usually discussed books. I turned her on to Audre Lorde. She shared some of her favorite works. I wish she was like this with me, but during a stress test, overheard her talking to another patient just as intimately. This was the way she cared for “her mothers”.

I ended up being induced early due to blood pressure issues.

She gave me the option of spending three days in the hospital of going home as soon as the baby was released. I chose to go home. Two days later, I received a call from the nurse who helped deliver my new baby girl. We chat about my experience and about how I was doing. I was being treated proactively for PPD as well. I would get at least four more calls before my six-week checkup.

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My Conclusion

I must say that the two experiences of having a baby before ACA and then having a baby under the ACA umbrella were worlds apart. The GOP is acting like “rolling back” the ACA provisions will “return” the insurance situation in our country to something better than we have. Well, “better” is in the eye of the beholder. If you are a working-class or poor woman having a baby without ACA protection, all I can say is “bless your heart.”

Before ACA made it mandatory to screen, check up on, and look for signs of the things like PPD and other pregnancy-related issues, doctors could just dismiss the mother’s concerns. In fact, there was no need to even see the same doctor twice. However, to screen for PPD, doctors have to talk to their patients and be aware of each individual mother’s situation. That means caring, talking to them, and in my case, listening to me when I tell you my baby was turning yellow and not brown.

I am still sure what good repealing ACA can do for pregnant moms. I just know that going back to the old system is not something I would wish on my worst enemy.

Written by

Jonita Davis is a writer, film critic, and professor. She’s a member of NABJ, AAFCA, a Rotten Tomatoes critic, and an adjunct professor.

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