The Supporting Healthy Moms and Babies Act inserts an explicit maternity and newborn care requirement into the ACA’s essential health benefits and prohibits any cost-sharing for those services in individual and group market plans, including ERISA‑governed employer plans. It specifies a minimum package of services—ultrasounds, care for spontaneous pregnancy loss, delivery services (including anesthesiology and fetal monitoring), certain postpartum medical and behavioral health services, and coverage for legal non‑birthing parents for a full year after birth.
Because the bill operates by amending the ACA, the Public Health Service Act, ERISA, and the Internal Revenue Code, it creates a uniform federal floor for maternity and newborn coverage and extends the elimination of point‑of‑care cost-sharing across most private plans. That clarity matters for employers, insurers, plan administrators, maternal‑health providers, and benefits counsel because it changes benefit design, claims costs, compliance obligations, and likely premium-setting dynamics.
At a Glance
What It Does
The bill adds an explicit maternity and newborn essential health benefit to 42 U.S.C. 18022(b) with a required services list and defines postpartum as the one‑year period after pregnancy ends. It then amends the Public Health Service Act, ERISA, and the Internal Revenue Code to prohibit any cost‑sharing (as defined in ACA section 1302(c)(3)) for those benefits for plan years beginning after enactment.
Who It Affects
Health insurance issuers offering individual and group coverage, self‑insured ERISA plan sponsors, Qualified Health Plans on the exchanges, employers that sponsor group health plans, and clinicians who deliver maternity, neonatal, and postpartum services.
Why It Matters
The bill makes a federal minimum coverage and cost‑sharing standard for maternity care, potentially reducing out‑of‑pocket barriers to care while shifting costs onto plans and premiums. It also standardizes postpartum behavioral‑health coverage for both birthing and non‑birthing legal parents for a full year, which could change utilization patterns and benefit design.
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What This Bill Actually Does
At its core, the bill does two things: (1) it names maternity and newborn care as an essential health benefit under the ACA and spells out minimum services; and (2) it bans any form of patient cost‑sharing for those services across most private insurance coverage by changing three federal statutes in parallel. The new essential‑benefit language requires coverage for comprehensive prenatal, labor and delivery, neonatal, perinatal, and postpartum care and screenings and then lists required items such as ultrasounds, services for spontaneous pregnancy loss, delivery‑related services (anesthesiology, fetal monitoring, specialist consults), and postpartum medical and behavioral health services.
The bill defines postpartum to run for one year after the pregnancy ends and explicitly includes behavioral health services for non‑birthing legal parents for that same year. It also cross‑references existing federal coverage requirements (the text cites section 2725 of the Public Health Service Act and related ERISA and Internal Revenue Code provisions), so the new language is meant to fold into the preexisting framework that governs preventive and women’s health services.To make the coverage meaningful at the point of care, the bill amends the Public Health Service Act to add a new provision that says plans “shall not impose any cost‑sharing requirements” for the newly required maternity/newborn benefits and then creates parallel prohibitions in ERISA and the Internal Revenue Code so that both insured and self‑insured employer plans are within scope.
It adopts the ACA’s statutory definition of cost‑sharing, which captures deductibles, copayments, and coinsurance. The amendments are effective for plan years beginning on or after enactment and the text includes language treating the changes as if they had been included in the original ACA enactment for statutory consistency.
The Five Things You Need to Know
The bill adds a dedicated paragraph to ACA section 1302(b) requiring comprehensive prenatal, labor and delivery, neonatal, perinatal, and postpartum care and screenings as an essential health benefit.
It defines 'postpartum' to mean the one‑year period immediately after the pregnancy ends, extending coverage and protections through 12 months post‑pregnancy.
For plan years beginning on or after enactment, the bill forbids any cost‑sharing—deductibles, copays, or coinsurance—for the specified maternity and newborn benefits across individual, group, and ERISA plans.
The required minimum services list explicitly includes ultrasounds, care for spontaneous pregnancy loss/miscarriage, delivery services (anesthesiology, fetal monitoring, specialist consultations), and services required under related PHS/ERISA/IRC provisions.
The bill requires behavioral‑health services for legal parents who do not physically give birth for the same one‑year postpartum period, extending mental‑health coverage to non‑birthing parents.
Section-by-Section Breakdown
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Short title — 'Supporting Healthy Moms and Babies Act'
This section provides the bill’s short name. It has no substantive effect on coverage or implementation but establishes the act’s title for statutory citation.
Adds explicit maternity and newborn essential health benefit and minimum services list
This is the substantive change to the ACA’s essential health benefits. It inserts a new paragraph requiring comprehensive prenatal, labor and delivery, neonatal, perinatal, and postpartum care and enumerates minimum services such as ultrasounds, miscarriage care, delivery services (including anesthesiology and fetal monitoring), postpartum medical and behavioral health services, and behavioral health services for legal non‑birthing parents. It also defines postpartum as the one‑year period after pregnancy ends. Practically, this creates a federal floor for what must be covered in the small‑group and individual markets and for Qualified Health Plans.
Prohibits cost‑sharing for the new maternity/newborn essential benefits
This provision adds a Public Health Service Act section that requires group health plans and health insurance issuers to provide the benefits described in the new ACA paragraph and prohibits any cost‑sharing for them, using the ACA’s definition of cost‑sharing. That means insurers cannot impose copays, coinsurance, or deductibles for these services under plans governed by the PHSA framework (typically insured individual and small‑group plans and QHPs). Regulators will need to interpret how this interacts with network design, prior authorization, and balance‑billing rules.
Extends the cost‑sharing ban to ERISA‑governed group plans
To capture self‑insured employer plans, the bill adds a parallel prohibition under ERISA that requires group health plans and issuers offering group coverage to provide the same benefits without cost‑sharing. Because ERISA governs many large employers’ self‑funded plans, this change is critical to ensure the cost‑sharing ban applies beyond fully insured plans. Plan sponsors and TPAs will have to amend plan documents, update SBCs (summary of benefits and coverage), and adjust claim‑payment operations to comply.
Tax code parity to prevent plan‑type loopholes
The bill inserts language into the Internal Revenue Code to align tax treatment with the PHSA and ERISA changes—requiring group health plans to meet the coverage and no cost‑sharing standard. The code amendment reduces the risk of heterogeneous treatment due to differing statutory obligations across tax‑qualified plans, and it signals that the IRS may have a role in enforcement or tax‑related compliance reviews of benefit design.
Timing and retroactivity clause
The amendments apply to plan years beginning on or after enactment. The bill also contains language treating these changes as if included in the original ACA enactment, which is intended to harmonize statutory text but creates questions about how state benchmark plans and prior regulatory guidance are adjusted—regulators will need to implement technical guidance to align state EHB benchmarks and exchange plan certification.
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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 and postpartum people with private insurance: They receive maternity, delivery, neonatal, and up to one year of postpartum care without copays, deductibles, or coinsurance, lowering immediate financial barriers to care.
- Non‑birthing legal parents (e.g., adoptive or gestational parents): The bill explicitly covers behavioral‑health services related to new parenthood for a year after birth, which increases mental‑health access for this group.
- Neonatal and maternal health providers: Providers may see reduced patient financial barriers, potentially increasing utilization of recommended prenatal and postpartum services and stabilizing revenue for covered services.
- Qualified Health Plans and individual market enrollees: Clear federal minimums simplify benefit design and consumer expectations for exchange plans, reducing variability across state markets.
Who Bears the Cost
- Health insurance issuers offering individual and small‑group plans: They must eliminate cost‑sharing for the enumerated services and will absorb or reprice those costs in premiums or reserve management.
- Self‑insured ERISA plan sponsors (many large employers): These sponsors face direct increases in plan expenses and administrative work to redesign benefits and update plan documents.
- Employers and employers’ benefits budgets: Particularly for smaller employers purchasing fully insured plans, premiums could rise to reflect the broader set of no‑cost services, affecting labor costs and benefits strategy.
- State regulators and marketplaces: States may need to reconcile their existing EHB benchmark plans with the new federal minimums, and exchanges will need updated plan certification processes and consumer communications.
Key Issues
The Core Tension
The central dilemma is access versus cost allocation: removing copays and deductibles at the point of care will likely increase use of recommended maternal and postpartum services and reduce a known barrier to care, but it shifts expense onto insurers, employers, and ultimately premiums, which could make coverage less affordable for some. Policymakers and regulators will have to decide whether the public‑health benefits of broader, free access outweigh the risk that plans respond with narrower networks, tighter utilization controls, or higher premiums that reintroduce affordability problems in another form.
The bill creates a clear federal floor for maternity and newborn coverage, but it leaves several implementation questions unresolved. It uses the ACA’s cost‑sharing definition to ban deductibles, copays, and coinsurance, but it does not address balance billing, facility fees, or the interaction with out‑of‑network charges—areas where patients can still face large bills despite zero cost‑sharing at point of service.
Regulators will need to issue guidance on scope (for example, which specific CPT/HCPCS codes fall under the new mandatory coverage) and on how prior authorization, utilization management, and medical‑necessity rules apply to services that must be covered without cost‑sharing.
Another operational tension concerns cost allocation. Eliminating point‑of‑care payments reduces financial barriers but increases plan liabilities; insurers and self‑insured employers are likely to recoup costs through premiums or other design changes (narrower networks, increased use of prior authorization, or shifted cost‑containment elsewhere).
The bill also cross‑references existing provisions (PHS Act §2725 and related ERISA/IRC citations), but those references rely on regulators to harmonize benefit lists and enforcement. Finally, the statute defines postpartum as one year after pregnancy ends and extends behavioral‑health coverage to non‑birthing legal parents, yet it does not define 'legal parent'—which could spawn coverage disputes that hinge on state family law or timing of legal parenthood determinations.
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