Mandating coverage for maternity length of stays: certain problems with the good idea.

I. INTRODUCTION II. STATE LEGISLATION REGULATING MATERNITY STAY COVERAGE A. Ohio's Maternity Length-of-Stay Law B. Maternity Standards Implemented in Cleveland III. NATIONAL LEGISLATION-THE FEDERAL ROLE IN HEALTH CARE IV. HOW THE REGULATIONS MAY AFFECT MATERNITY HEALTH CARE V. CONCLUSION I. INTRODUCTION The Newborns'and Mothers' Health Protection Act of 1996 (Newborns' Act), enacted on September 20, 1996, intends to ensure appropriate maternity health care for insured mothers and their newborn infants by mandating increased insurance coverage.(1) Specifically, insurance groups, health maintenance organizations (HMOs), and private payors who offer maternity coverage must cover at least forty-eight or ninety-six hours of post-natal hospital care.(2) The Newborns' Act, along with several and similar state laws, percolated during the 1996 presidential election.(3) The state legislation, including Ohio's Maternity Length-of-Stay Law (Maternity Law), nearly mirror the federal law of which New Jersey law served as the blueprint.(4) The combined state and federal maternity laws intend to affect all payors which offer maternity health care coverage for mothers and newborns. The battle ensued when insurers and HMOs (payors) imposed policy restrictions to achieve cost effective, quality maternity health care.(5) Medical groups, disagreeing with the policy restrictions, faced professional and financial incentives to either accept the policy or seek a new payor.(6) Likewise, consumers faced financial burdens for violating the policy.(7) Thus, Most physicians and consumers grudgingly accepted the payor policy. Payors felt that they effectively and appropriately contained Costs.(8) However, certain medical and consumer groups considered the payor policies as harmful to both mother and newborn.(9) Medical groups petitioned first the state then the federal governments for legislative protection and intervention. The combined state and federal law intends to promote appropriate maternity health care. Unfortunately, the law fails to protect uninsured mothers and newborns. Also, the law indirectly standardizes maternity health care which may burden the evolution of maternity health care. Federalism poses an interesting question for the Newborns' Act. Does America want its federal government to regulate maternity health care? Health care remains a local issue retained by the existing states at the United States (U.S.) Constitution's ratification. Over the years, the federal government has chipped away at the states' exclusive control of health care by legislating in health-related areas under other constitutionally delegated powers such as the spending and commerce powers. Americans ought to consider the consequences of unbalanced federalism when the federal government legislates in traditional state powers. For simplification, the current payor trends, such as hospitals owning insurance companies and vice versa, will be condensed and generalized with insurance providers, HMOs, and other maternity payors as "payors." Likewise, not every medical group (certainly not the HMOs) advocated for state and federal legislation restricting payors in maternity health care. For simplification, any general mention of the medical profession or medical groups indicates those medical associations that advocated for the Newborns' Act. This paper will outline the issues influenced by the Newborns' Act and the Maternity Law, including federalism. Likewise, the paper examines certain shortcomings of the maternity legislation. Section II focuses on Ohio's Maternity Law and whether it will prove effective as exemplified by Cleveland's maternity health care standards. Section III addresses the Newborns' Act and how it will influence federalism. Additionally, section III compares the Newborns' Act to the Maternity Law Section IV explores how the concurrent regulations may affect maternity health care. …