Despite the higher premiums paid by women, 90% of individual health plans didn’t provide any routine maternity benefits prior to the ACA.
And in all but five states, being pregnant was a pre-existing condition that prevented a woman from purchasing individual health insurance at all. (In most states, expectant fathers were also denied coverage, due to laws that require health insurance companies to automatically cover a member’s newborn child. To mitigate against the risk of having to cover a newborn with complications, most individual market insurers rejected applications from expectant parents, including both mothers and fathers.)
Many individual health plans offered no coverage for contraceptives, and coverage for women’s preventive care varied considerably from one state to another.
Prior to ACA implementation, some states had taken action to mitigate gender inequality in health insurance. By 2012, 14 states had banned or restricted gender-based premiums in the individual market, 17 had done so for the group market, and nine states had laws requiring maternity coverage in the individual market. But in most states, gender discrimination was still the norm until 2014.