SSB 5075
In CommitteeSenate
Prenatal and postnatal care
Concerning cost sharing for prenatal and postnatal care.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill prohibits most health plans that cover maternity services from charging patients out-of-pocket costs (like copays or deductibles) for prenatal and postnatal care services, starting in 2026. It includes a narrow exception for plans tied to health savings accounts to comply with federal tax rules.
- Starting January 1, 2026, health plans that cover maternity services must provide covered prenatal services (e.g., office visits, lab tests, ultrasounds, prescriptions, prenatal vitamins) with no copays, coinsurance, or deductibles.
- Postnatal services (e.g., office visits, lactation support, C-section follow-up, counseling, prescriptions) must also be provided with no cost-sharing.
- A limited exception allows health savings account (HSA)-eligible plans to set minimal cost-sharing only to the extent required to maintain their HSA-qualified status under federal tax rules.
- The law applies to health plans issued or renewed on or after January 1, 2026—including employer-sponsored, individual, and Medicaid-managed care plans.
Who is affected
- People with health insurance covering maternity services — People with employer-sponsored, individual, or Medicaid-managed care health plans that include maternity coverage—these plans must eliminate copays, coinsurance, and deductibles for covered prenatal and postnatal services starting in 2026.
- Pregnant individuals and new parents — Pregnant individuals and new parents who use covered services like office visits, ultrasounds, lab tests, prescription drugs, and postpartum counseling will no longer pay out-of-pocket for those services (with limited exceptions).
- Health insurance carriers — Health insurance companies and carriers must adjust their plan designs and billing systems to comply with the new no-cost-sharing requirement for maternity services.
- People with HSA-eligible health plans — People with high-deductible health plans (HDHPs) that are paired with health savings accounts (HSAs) may face special rules to ensure their plans still qualify as HSA-eligible while meeting the no-cost-sharing mandate.
Pro/Con Analysis
Potential Benefits (5)
Directly improves access to essential maternal health services by eliminating financial barriers for a vulnerable population during a critical window—this is a targeted, evidence-based intervention that aligns with public health goals to reduce maternal mortality and disparities.
HealthcarePeopleRef: Sec. 1(1)Supports public safety by reducing emergency department visits and hospitalizations for complications that could be prevented with timely prenatal care, easing strain on emergency and public health systems.
Public SafetyPeopleRef: Sec. 1(1)May reduce employer-sponsored insurance administrative burden related to maternal care billing and cost-sharing coordination, though savings are likely modest relative to overall plan costs.
Business & EmploymentPeopleRef: Sec. 1(1)By improving maternal health and reducing parental stress, this may support better early childhood development and school readiness, though evidence is indirect and long-term.
EducationLean peopleRef: Sec. 1(1)Reduces risk of medical debt and housing instability for families during a high-vulnerability period, though direct data on this specific bill’s housing impact is not provided.
HousingLean peopleRef: Sec. 1(1)
Potential Concerns (5)
Eliminates out-of-pocket costs (copays, coinsurance, deductibles) for prenatal and postnatal care services for most insured pregnant individuals and new parents, directly reducing financial burden for a high-need, time-sensitive medical episode.
HealthcarePeopleRef: Sec. 1(1)May improve maternal and infant health outcomes by removing financial barriers to recommended prenatal and postnatal care, potentially reducing complications and infant mortality—evidence from prior studies (e.g., Medicaid expansions, ACA preventive care mandates) shows cost-sharing removal increases utilization and improves outcomes.
Public SafetyPeopleRef: Sec. 1(1)Reduces financial strain on low- and middle-income families during a high-stress life transition (pregnancy/infancy), potentially lowering risk of housing instability due to unexpected medical debt.
HousingPeopleRef: Sec. 1(1)By reducing financial stress and improving maternal health, this may indirectly support better early childhood development and school readiness, though evidence is indirect and long-term.
EducationLean peopleRef: Sec. 1(1)The HSA exception may limit cost-sharing relief for some enrollees in high-deductible plans, but only to the minimal extent required to preserve HSA tax status—federal rules cap HSA-qualifying deductibles at $1,600 (individual)/$3,200 (family) in 2025, so impact is narrow and unlikely to offset broad benefits.
HealthcareLean peopleRef: Sec. 1(2)
Who Is Most Affected
Pregnant individuals and new parents—especially low- and middle-income families—will directly benefit from eliminated out-of-pocket costs for essential care, improving access and reducing financial stress.
Health insurers will need to redesign plan benefits and billing systems, but the fiscal impact is expected to be modest: utilization may rise slightly, but the services covered are already standard and low-to-moderate cost (e.g., office visits, labs, ultrasounds), and risk pools include both men and women, diluting cost concentration.
People with HSA-eligible HDHPs may face minimal cost-sharing (e.g., up to $1,600 deductible in 2025) to preserve HSA tax status, but they retain access to the services—this is a technical compliance burden, not a substantive barrier.
Healthcare providers (hospitals, clinics, OB-GYNs) may see increased utilization and more predictable billing (no surprise copays), but no direct revenue change is guaranteed—reimbursement rates remain unchanged.
State government and Medicaid agencies benefit from reduced uncompensated care and potential long-term savings in maternal/infant health outcomes, though the bill does not allocate new funding and costs are primarily absorbed by private insurers.