The New York Times recently reported that in some states with certain carriers, women could be declined for rated up for individual insurance based on past Caesarean section births. Unlike group coverage sponsored by employers, with individual insurance, companies can choose the conditions they cover and base the price on a person’s medical history. This often works in favor of those seeking affordable health insurance coverage. The number of people looking for individual health insurance is currently about 18 million and has been growing steadily over recent years. Although most Americans, 160 million, have group coverage it is estimated that the number seeking individual coverage will continue to rise as more people are becoming self-employed or taking jobs without health benefits.

It may not seem right for insurers to rate up or decline people applying for coverage based on their medical history, but these practices are necessary to protect insurance companies, because customers often apply only after they become ill or pregnant, skewing the pool toward people with high expenses.

So, although many women who have previously had a Caesarean can safely have a natural birth later, in the last decade many doctors and hospitals have refused to allow a natural birth for the second child because it carries a small risk of a potentially fatal complication: uterine rupture. Therefore, some insurers treat a previous C-section like a preexisting condition, where someone has an illness which will foreshadow the potential for higher costs in the future. A Caesarean costs an average of $2700 more than a vaginal birth when no complications are involved. As a result, though insurers’ rules on prior C-sections vary by company and state (states regulate insurers), some providers will deny coverage outright (unless the woman has been sterilized afterwards), increase premiums or deductibles indefinitely or for a set number of years, or attach a rider excluding coverage for a C-section delivery for a period of years. In some instances though, as with several Texas companies, insurers will ignore the prior C-section as long as the woman has fully recovered.

Just as the rate of those searching for individual insurance coverage has increased with the times, so has the rate of Caesarean births (now at a high of 31.1%, over 1.2 million performed in the U.S. in 2006 alone). The problem with all of this for women with prior C-sections now seeking individual coverage is that although some C-sections are emergency, a growing number of them are elected C-sections or are unelected C-sections pushed on women by their doctors. Insurers point to women and OB-GYNS who schedule unneeded C-sections out of convenience: delivering the baby on a certain date and time or to avoid labor. Spokespeople for organizations such as the International Caesarean Awareness Network claim furthermore that “obstetricians are rendering large numbers of women uninsurable by overusing this surgery” when it is not necessary because of emergency.