The bill amends the Affordable Care Act to add comprehensive prenatal, labor and delivery, neonatal, perinatal, and postpartum services to the ACA’s essential health benefits (EHBs), specifies a one‑year postpartum period, and lists minimum required services (ultrasounds, miscarriage care, delivery services including anesthesiology and fetal monitoring, postpartum medical and behavioral health, and parity with existing maternity statutes).
It then prohibits any cost‑sharing for those maternity and newborn EHBs across group and individual market coverage by adding parallel provisions to the Public Health Service Act, ERISA, and the Internal Revenue Code, making the requirement applicable to insured and self‑insured group plans for plan years beginning on or after enactment. The change removes financial barriers to maternity care but raises questions about premium and plan design impacts, enforcement, and operational details for plan administrators and providers.
At a Glance
What It Does
The bill inserts an explicit maternity and newborn EHB into ACA section 1302(b) with a laundry list of minimum services and defines postpartum as the 1‑year period after pregnancy. It then adds statutory prohibitions on cost‑sharing for those benefits to the Public Health Service Act, ERISA, and the Internal Revenue Code so insured and self‑insured plans must cover them without copays, coinsurance, or deductibles.
Who It Affects
Individual market issuers, small‑group and large‑group plans, and self‑insured employer plans (through ERISA/IRC amendments) will be directly affected. Insurers and plan administrators will need to redesign benefits and pricing; pregnant people, newborns, and legal (non‑birthing) parents will see reduced out‑of‑pocket costs for specified services.
Why It Matters
This is a federal floor expanding EHBs and removing cost barriers for a set of maternal services across most private coverage, not just Marketplace plans. By amending ACA, ERISA, and the tax code in parallel, the bill aims to close common coverage gaps that leave peripartum care subject to deductibles and coinsurance.
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What This Bill Actually Does
Section 2 rewrites the ACA’s essential health benefits to include a clearly enumerated package for maternity and newborn care. Instead of leaving maternity coverage to state benchmark variability, the bill inserts a new paragraph describing mandatory coverage for comprehensive prenatal care, labor and delivery, neonatal and perinatal care, and postpartum care and screenings.
It sets a floor of minimum benefits — for example, ultrasounds by a licensed provider, coverage for care related to spontaneous pregnancy loss, delivery services such as anesthesiology and fetal monitoring, coverage of services already referenced in other federal maternity statutes, and postpartum medical and behavioral health for conditions linked to pregnancy.
The bill defines postpartum to mean the full year after the pregnancy ends and specifically extends behavioral health coverage for the one‑year postpartum period to legal parents who did not give birth, ensuring non‑birthing legal parents can receive new‑parent behavioral health services. That inclusion is notable because it addresses a coverage gap where some plans treat non‑birthing parents differently.Section 3 implements the no cost‑sharing rule.
It adds a new PHS Act section that requires group and individual health insurance coverage to provide the maternity and newborn EHBs without any cost‑sharing, pointing to the ACA’s definition of cost‑sharing. Parallel amendments to ERISA and the Internal Revenue Code make the prohibition effective for employer‑sponsored and self‑insured plans as well, so the reach is broad: insured market plans and self‑insured employer plans are both subject to the ban on copays, coinsurance, and deductibles for the enumerated services.The bill applies to plan years beginning on or after enactment and instructs that these changes be treated as if included in the ACA’s original enactment; that language is designed to integrate the amendment into existing statutory frameworks and enforcement authorities.
Operationally this will force plan sponsors and issuers to review benefit designs, update summary plan descriptions and SBCs, and reconcile cost‑sharing eliminations with network reimbursement arrangements and high‑deductible plan structures.
The Five Things You Need to Know
The bill amends ACA section 1302(b) to add a new mandatory maternity and newborn essential health benefit with a defined minimum scope of services.
It defines ‘postpartum’ as the 1‑year period after pregnancy and requires postpartum behavioral health coverage, including for legal parents who did not give birth, for that year.
The bill bars all cost‑sharing (copays, coinsurance, deductibles as defined in ACA section 1302(c)(3)) for the listed maternity and newborn services in individual and group market coverage.
Parallel amendments to the Public Health Service Act, ERISA, and the Internal Revenue Code extend the no‑cost‑sharing requirement to insured and self‑insured employer plans for plan years beginning on or after enactment.
It cross‑references existing federal maternity coverage statutes (PHS Act sec. 2725, ERISA sec. 711, and IRC sec. 9811) to ensure services already required under those provisions are covered without cost‑sharing.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title — Supporting Healthy Moms and Babies Act
Sets the act’s short title. This is boilerplate but important for cross‑referencing the statute in regulations, guidance, and litigation.
Adds Maternity and Newborn Care to ACA Essential Health Benefits
Inserts a new paragraph into ACA section 1302(b) that makes comprehensive prenatal, labor and delivery, neonatal, perinatal, and postpartum care part of the essential health benefits package. The provision lists minimum services that plans must cover, from ultrasounds to miscarriage care and delivery‑related services like anesthesiology and fetal monitoring. By specifying minimums, the provision constrains state benchmark variability and creates a federal baseline for maternity coverage.
Defines Postpartum and Expands Behavioral Health Coverage
Defines ‘postpartum’ as the 1‑year period after pregnancy ends and requires coverage of postpartum medical and behavioral health services for pregnancy‑related conditions. It uniquely mandates behavioral health services for legal parents who did not give birth during the same 1‑year postpartum window, which brings intended parents and some adoptive or surrogate arrangements explicitly into the statutory protection.
Prohibits Cost‑Sharing in Individual and Group Market Coverage
Adds a new section to the Public Health Service Act requiring group and individual health insurance coverage to provide the ACA maternity and newborn benefits without any cost‑sharing, using the ACA’s definition of cost‑sharing. This directs HHS regulators to enforce a no‑cost‑sharing standard for the enumerated services in the insured markets tied to ACA enforcement mechanisms and plan certification processes.
Extends the No‑Cost‑Sharing Requirement to Employer Plans and Tax Law
Adds parallel provisions to ERISA (new section 726) and the Internal Revenue Code (new section 9826) so that employer‑sponsored group plans, including many self‑insured arrangements, must comply. The ERISA amendment places the obligation squarely on plan sponsors/administrators and creates a statutory hook for DOL enforcement; the IRC insertion aligns tax treatment and penalties with the statutory requirement to ensure consistency across federal oversight regimes.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Pregnant people and birthing parents — They gain elimination of out‑of‑pocket costs for a specified set of prenatal, delivery, neonatal, and postpartum services, reducing financial barriers to care.
- Newborns and infants — Broader guaranteed coverage of neonatal services and screenings can increase access to early care without cost‑sharing that often deters follow‑up.
- Non‑birthing legal parents — The bill explicitly covers behavioral health for legal parents who did not give birth for the one‑year postpartum period, expanding mental‑health access to intended parents, adoptive parents, and some surrogacy arrangements.
- Plans and HR teams focused on benefit parity — Employers and issuers seeking to standardize maternity benefits get a single federal floor to build from, simplifying benefit design decisions across states.
Who Bears the Cost
- Health insurers — Insured market plans will absorb added costs from eliminating cost‑sharing for services they previously collected copays or deductibles for; those costs may be reflected in premiums.
- Self‑insured employers and plan sponsors — ERISA and IRC changes make self‑funded plans directly responsible for covering these services with no member cost‑sharing, potentially increasing employer healthcare expenditures.
- Plan administrators and compliance teams — They must update plan documents, SBCs, claims adjudication rules, and vendor contracts to remove cost‑sharing and ensure benefits meet the enumerated minimums.
- State regulators and marketplaces — States may need to reconcile existing benchmark plans and rate filings with the new federal floor, and rating agencies may see recalibration of premiums and actuarial assumptions.
Key Issues
The Core Tension
The central policy tension is between removing immediate financial barriers to essential peripartum care — which promotes access and health equity — and the fiscal and operational consequences of absorbing those costs across private coverage, which can raise premiums, strain provider reimbursement negotiations, and create administrative complexity; the bill favors access but leaves pay‑for and implementation challenges unresolved.
The bill sets a broad, federally enforceable floor for maternity and newborn benefits and removes cost‑sharing, but it leaves implementation details to existing regulatory frameworks. It does not specify reimbursement rates, how bundled delivery payments interact with the no‑cost‑sharing rule, or how out‑of‑network billing will be handled when a patient faces cost‑sharing at the point of care.
Those operational gaps could prompt disputes between providers, issuers, and plan sponsors. The cross‑statute approach (PHS Act, ERISA, IRC) ensures broad coverage scope but creates complexity: multiple agencies (HHS, DOL, IRS) will need to coordinate guidance and enforcement, and differences in enforcement mechanisms across those statutes could produce uneven compliance.
Economically, eliminating cost‑sharing reduces point‑of‑care financial barriers but is likely to increase plan costs. The bill does not include offsets, risk adjustment changes, or transitional funding, so higher premiums or employer contributions are possible.
The mandate’s interaction with high‑deductible health plans and Health Savings Accounts is unclear; removing cost‑sharing for specified services while preserving deductible structures elsewhere may require regulatory clarifications to avoid undermining HSAs or creating unexpected tax consequences.
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