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Lawmakers in the House are considering a bipartisan bill that could help parents hold down health care bills for newborn babies but expose the parents' health plans to antiselection risk.
Rep. Sharice Davids, D-Kan., introduced the "Empowering Parents' Healthcare Choices Act" bill with support from Rep. Gabe Evans, R-Colo.
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The bill would apply to a couple that has a baby. If each parent gets coverage from a separate employer-sponsored health plan, the parents would have 60 days to decide which plan would provide coverage for the baby.
Davids introduced a similar bill in 2021. That bill died in committee.
The birthday rule: Today, Davids said, plans use the "birthday rule" to decide which parent's plan covers the baby.
The birthdate rule states that the health plan of the parent with the birthday that comes earlier in the year covers the baby.
"Insurance companies often do not inform parents of this policy, which can result in surprise medical bills," Davids said.
She cited the example of an Olathe, Kansas, family that ended up with $270,951 in out-of-network hospital bills because of the impact of the birthday rule.
The impact: If the Davids bill became law and was enacted as written, it could protect parents from a kind of "surprise medical bill."
A surprise medical bill is a large out-of-pocket expense incurred by people with health coverage who think they are following the rules of their coverage and getting covered care from in-network providers.
But the bill could also expose employer plans to extra claim risk.
Related: Employers' $1M health claim rate rises 29%
By giving new parents a choice between two plans, the bill would encourage the parents to push the claim costs associated with the birth to the plan with more generous coverage.
That could encourage plans to water down benefits for maternity and newborn care and lead to higher costs for plans to offer rich maternity and newborn care benefits.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
