The Trump White House seems confused about how pregnancy works

Let me teach you about the birds and the bees.

CREDIT: AP Photo/Andrew Harnik
CREDIT: AP Photo/Andrew Harnik

The House is expected to vote Friday on a bill that, if a faction of the most conservative House Republicans gets its way, will eliminate the requirement that insurance plans cover certain essential health benefits. These benefits include maternity care, a fact that the Trump White House views as an opportunity to pit men against women.

It’s a common joke among the Affordable Care Act’s opponents. Why should a man pay for women’s health care? Hilarious!


At least with respect to maternity care, however, there’s a very simple answer to this question. Because of the unusual nature of pregnancy, either everyone must pay for pregnancy coverage, or no one will have pregnancy coverage.

The reason why is a problem known as “adverse selection.”

Adverse selection is one of the most daunting problems in health care policy. It occurs when people who are at especially high risk opt into insurance while people who are especially low risk opt out. In the health insurance context, it means that sick people are especially likely to buy insurance — since they stand to draw more money out of an insurance pool than they pay into it . Meanwhile, healthy people are more likely to not buy insurance, as they are likely to pay more in premiums then they receive in benefits.

Nevertheless, most healthy people still buy health insurance, because many health expenses are unpredictable. Even the healthiest person on the planet can be hit by a bus or unexpectedly contract a serious illness, so it’s a good idea for everyone to buy health insurance to hedge against this uncertain risk.

But pregnancy is not such an uncertain risk. Cisgender men, as Spicer archly notes, cannot become pregnant. Post-menopausal women cannot become pregnant. Women who do not have sex with men are quite unlikely to become pregnant. And even partnered, heterosexual, cisgender women are very unlikely to become pregnant if they use modern forms of contraception.


Thus, in a world where people can choose not to have a health plan that covers maternity care, most people will opt out of such coverage. Indeed, virtually the only population that will opt into such coverage are fertile, female-bodied individuals who are actively trying to become pregnant.

But that’s not a viable insurance pool. The entire point of insurance is that there must be enough people paying more money into the pool than they are taking out of it in order to cover the costs of everyone in the pool. And that’s not going to happen if virtually everyone in the maternity insurance pool waits until they start trying to become pregnant to obtain pregnancy coverage.

Unless the law includes some mechanism to pull people who aren’t actively seeking to become pregnant into the maternity care insurance pool, the pool will collapse and no one will receive insurance coverage for their pregnancy.