That changed in August. After trying for “a really long time” to conceive a second child, she suffered an early miscarriage at home one weekend. She couldn’t go to work that Monday. “I was really traumatized,” she said. “That entire first week was like a heightened level of emotion that I hadn’t really been through before.” She also had a doctor’s appointment to ensure she wasn’t experiencing an ectopic pregnancy, which would have required immediate surgery.

She had emailed her bosses, informing them of the miscarriage and her need to take Monday off, which she had enough paid leave to cover. Because of the pandemic, she had been working from home several days a week and opted to do that again Tuesday because she was still bleeding and her face was “so puffy from crying,” she said. She returned to the office, as scheduled, on Wednesday, she said, and then, given that her managers were out of the office, worked from home the rest of the week.

The following week, 10 days after her miscarriage, one of the company owners called her and fired her, allegedly for working from home repeatedly, even though others at the firm had similar hybrid schedules, according to Makkar. She was “shocked.”

When Makkar reminded him that she had worked from home because of her miscarriage, she said he responded, “When my wife had a miscarriage in the beginning of our marriage, she only took a half a day off work.”

Getting fired right after her miscarriage “was really, really awful,” she said through tears. “You’re already so devastated, and it’s just another blow.”

Makker filed a complaint based on her allegations against J&B with the Colorado Civil Rights Division, accusing the company of gender and pregnancy discrimination for her firing, in violation of Colorado state laws. “This shouldn’t have to happen to other women,” she said.

Makkar’s lawyer, David E. Gottlieb, said they “intend to file a lawsuit in the coming months in Colorado state court.”

A lawyer for J&B said its policy is not to comment on ongoing litigation and declined to provide any responses the company may have filed with the state. “We’re just confident that once the facts are reviewed the company will be vindicated,” he said.

Miscarriage, which occurs in of all pregnancies, is the most common form of loss of a pregnancy. And yet there are no national laws that protect people when they need time off from work to deal with the loss.

The physical needs of someone who experiences a miscarriage vary greatly. Within the first week or two, symptoms may resemble a heavy menstrual period with cramping and some pain. The later in the pregnancy that a miscarriage occurs, the more likely there will be significant bleeding, “to the point where it leads to anemia in some cases,” said , a reproductive endocrinologist and fertility specialist with CCRM San Francisco. Some people have such heavy contractions that they need pain management, he added. Miscarriages in the second trimester or later may require procedures needing hospital admission. The aftereffects are often unpredictable and can last for weeks or months.

“Miscarriage is not a one-and-done thing at all,” Salem said. “It drags on physically, mentally, and emotionally.”

The emotional aspect “can be a very traumatic experience,” noted , a professor of communications studies at Indiana University who has studied miscarriage for a decade. Some people blame themselves even though the vast majority of early miscarriages are due to chromosomal abnormalities beyond people’s control. Compounding the grief is the lack of established rituals that accompany other losses, as well as a stigma some people attach to miscarriage.

In the wake of such trauma, “it’s very difficult to focus,” Brann said. “An individual is probably not going to be as productive.”

“It is really important that we encourage women to take care of themselves,” Brann said. Otherwise, the grief won’t be processed and it can “cause even greater mental anguish later on.”

More people are speaking out about the experience of miscarriage, including high-profile women like , , and actress .

But many workers find it difficult to get time off from work. The federal Pregnancy Discrimination Act prohibits employers from treating workers who are pregnant, give birth, or have related medical conditions — including miscarriage — worse than comparable co-workers. Courts, however, have interpreted that law differently, even after a decided in favor of a plaintiff who claimed pregnancy discrimination. Judges have dismissed in the aftermath, according to a review by A Better Balance, a national legal nonprofit promoting workplace rights.

— including Colorado — have enacted laws that require employers to offer workers accommodations related to pregnancy, which can include time off to recover from a miscarriage. But outside those states, workers are protected only by the pregnancy act or the Americans with Disabilities Act, if a miscarriage is severe enough to substantially limit a “life activity.”

Currently, , also including Colorado, have enacted laws requiring some employers to provide paid sick leave to workers for medical needs, such as for the physical and mental health impacts of miscarriage. They don’t require employees to say why they need the time off, other than perhaps producing a doctor’s note.

“It’s not putting the onus on the worker to have to reveal something that might be very personal and very sensitive,” said , a senior policy counsel at A Better Balance.

have paid family leave programs, which can be used for more serious complications resulting from miscarriage. Elsewhere workers can take unpaid leave through the Family and Medical Leave Act if they qualify.

To fill the gaps, Sen. Tammy Duckworth (D-Ill.) and Rep. Ayanna Pressley (D-Mass.) that would ensure three days of paid leave for miscarriage and other fertility challenges. Democrats have also put forward to guarantee paid sick leave, and they’ve included paid family leave in President Joe Biden’s social spending plan, although that provision is meeting stiff opposition from some lawmakers and the bill is languishing in Congress.

Makkar is living with the repercussions of her miscarriage. “It’s all so traumatizing still,” she said. She’s trying to find a new job, but the search is complicated. She’s “terrified of getting myself in this situation again,” she said, because she wants to have more children. “I don’t want to be somewhere that that’s not going to be supported.”

This <a target="_blank" href="/mental-health/miscarriage-worker-leave-legislation-pregnancy-benefits-discrimination/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

It was all explained “super quick,” she said, with no details on what the insurance would cover. When she arrived in the United States, she recalled, a representative of the au pair agency recommended she buy extra coverage for sports, because even an accident caused by jumping could be considered sports-related. Mabel opted to purchase the extra policy for an additional $180.

In August 2017, she had her birth control implant removed because it had expired, something she assumed would be covered by her insurance, given birth control coverage is of Mexico’s . Instead, she said, she got a bill for about $4,500. Her insurance didn’t cover contraception or other reproductive health care, she said.

According to the State Department, 14 au pair agencies operate in the U.S. These private companies are required to offer their au pairs basic health coverage under State Department regulations. But some of the plans amount to emergency or travel insurance, excluding many types of necessary care, according to Natalia Friedlander, a staff attorney at the , a nonprofit public interest law center. After an au pair she employed had problems with health coverage, Friedlander examined insurance offered by about half those agencies in 2020 and her center posted to help au pairs find comprehensive coverage.

She found that agencies might not mention that au pairs are eligible to enroll in comprehensive coverage on the Affordable Care Act marketplaces or that many au pairs may qualify for subsidies to help pay their premiums. By failing to enroll, au pairs could wind up with huge medical bills if they need care.

A spokesperson for the State Department said those 14 agencies are subject to the as other groups that sponsor exchange visitor programs and must require the au pairs to “have insurance in effect that covers the exchange visitors for sickness or accidents during the period of time that they participate in the sponsor’s exchange visitor program.” The criteria laid out in the federal regulations include medical benefits of at least $100,000 per accident or illness, a deductible limit of $500 per accident or illness, and a maximum coinsurance limit of 25% of the cost of covered benefits — but they don’t stipulate that the comprehensive coverage required for Americans must be provided.

Neither do the regulations suggest au pairs or other exchange visitors be informed about access to ACA marketplace plans. Mabel and two other former au pairs, whose time working in the program spanned 2014 to June of this year, told KHN that no one ever mentioned the ACA to them when they signed up for work or after they arrived in the U.S.

KHN reached out to each of the 14 au pair agencies under the purview of the State Department about the insurance plans they offer employees. Only one responded.

Terence Burke, a spokesperson for Cultural Care Au Pair, said the insurance offered to its au pairs exceeds regulations set up by the State Department to meet medical expenses and other travel coverage, and provides emergency evacuation from the country if needed, another State Department requirement.

“Au pairs with Cultural Care are given detailed information on exactly what is and what is not covered in their insurance coverage. Knowing that information, au pairs are always free to supplement or add to the insurance coverage they must have in accordance with the U.S. State Department regulations and can choose to enroll in an ACA exchange to supplement their medical coverage,” he wrote in an email.

At least two of the agencies with some of the longest-running programs in the U.S. are owned by companies that also offer insurance. Cultural Care insurance through Erika Insurance, and both companies are EF Education First, a Swedish company. Au Pair in America insurance through Cultural Insurance Services International, both part of the British company American Institute for Foreign Study.

Friedlander found that the insurance plans offered to many au pairs before they arrive exclude certain categories of care deemed essential under the ACA. Many didn’t cover routine or preventive services, or care for preexisting conditions, mental health, and maternity and reproductive health, she said. Some plans are advertised as “comprehensive,” “exceptional” or “worry free,” although they do note the coverage exclusions.

In addition, she said, the insurance coverage summaries or orientation materials she reviewed did not mention ACA marketplace plans as an option.

Au pairs on J-1 visas are classified as foreign nationals living in the U.S. on non-immigrant visas, because they’re not on a path to citizenship. The ACA such non-immigrants. According to a spokesperson for the Centers for Medicare & Medicaid Services, the federal agency that oversees the ACA marketplaces, “We encourage organizations that facilitate the J-1 visa exchange programs to communicate the opportunity to enroll in quality, affordable healthcare through the Marketplace. J-1 visa holders are considered lawfully present and are therefore eligible to enroll in a qualified health plan through the Marketplace, and for financial assistance, if otherwise eligible.”

CMS noted, however, that anyone seeking subsidies to help cover the cost of premiums must plan to file a federal income tax return for that year.

If the insurance au pairs carry through their agencies doesn’t meet the minimum coverage requirements under the ACA, Friedlander said, they are free to enroll.

But the enrollment window is strict: People in the U.S. to sign up for ACA plans outside the annual open enrollment period.

Friedlander said that, when she first looked into insurance for her au pair, “I assumed she would have comprehensive coverage.” She said she was surprised to see large limitations.

Having previously worked at a health insurance-related nonprofit, Friedlander first investigated whether the au pair could enroll in ACA coverage. It took effort because the ACA marketplace navigators weren’t familiar with J-1 visa holders, but she managed to get her au pair enrolled. She has since signed up two of her other au pairs.

But for many au pairs, ACA coverage is not an obvious option. They are typically not native English speakers, very young and living with their employers, which leaves them dependent on their host families. “That’s a situation where they really are reliant on the agencies to provide them information that they need to know while in the United States,” Friedlander said.

For Mabel, her medical bills changed her experience in the U.S. What she owed the hospital and doctor, she noted, would have been enough to buy round-trip tickets to Mexico to have her implant removed there. To save the money to pay off her debt, she said, she stopped doing anything outside of working. “Basically, the purpose of the exchange, go traveling around, it stopped there, it finished, because I acquired this responsibility,” she said. She was able to pay it off over the course of two years, she said.

“It was my biggest mistake, financially talking, of my whole life,” she said.

Estefania Weinbach, of Colombia, said that in 2016, two years after coming to the U.S. to work as an au pair, she experienced a sharp pain in her abdomen that felt like being stabbed. At an emergency room, she was diagnosed with endometriosis and was told she needed surgery within weeks, she recalled.

She said she was told by a representative of her au pair agency that the surgery would be covered in her home country and was advised to fly back immediately. Weinbach refused. The agency told her the insurance would cover surgery expenses up to $7,000, she said, and she found a doctor willing to perform the operation for that payment. But it was a “very traumatic experience,” one that made her feel “everything is against you.”

This <a target="_blank" href="/health-care-costs/au-pair-health-coverage-gaps-affordable-care-act-plans/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

That changed in August. After trying for “a really long time” to conceive a second child, she suffered an early miscarriage at home one weekend. She couldn’t go to work that Monday. “I was really traumatized,” she said. “That entire first week was like a heightened level of emotion that I hadn’t really been through before.” She also had a doctor’s appointment to ensure she wasn’t experiencing an ectopic pregnancy, which would have required immediate surgery.

She had emailed her bosses, informing them of the miscarriage and her need to take Monday off, which she had enough paid leave to cover. Because of the pandemic, she had been working from home several days a week and opted to do that again Tuesday because she was still bleeding and her face was “so puffy from crying,” she said. She returned to the office, as scheduled, on Wednesday, she said, and then, given that her managers were out of the office, worked from home the rest of the week.

The following week, 10 days after her miscarriage, one of the company owners called her and fired her, allegedly for working from home repeatedly, even though others at the firm had similar hybrid schedules, according to Makkar. She was “shocked.”

When Makkar reminded him that she had worked from home because of her miscarriage, she said he responded, “When my wife had a miscarriage in the beginning of our marriage, she only took a half a day off work.”

Getting fired right after her miscarriage “was really, really awful,” she said through tears. “You’re already so devastated, and it’s just another blow.”

Makker filed a complaint based on her allegations against J&B with the Colorado Civil Rights Division, accusing the company of gender and pregnancy discrimination for her firing, in violation of Colorado state laws. “This shouldn’t have to happen to other women,” she said.

Makkar’s lawyer, David E. Gottlieb, said they “intend to file a lawsuit in the coming months in Colorado state court.”

A lawyer for J&B said its policy is not to comment on ongoing litigation and declined to provide any responses the company may have filed with the state. “We’re just confident that once the facts are reviewed the company will be vindicated,” he said.

Miscarriage, which occurs in of all pregnancies, is the most common form of loss of a pregnancy. And yet there are no national laws that protect people when they need time off from work to deal with the loss.

The physical needs of someone who experiences a miscarriage vary greatly. Within the first week or two, symptoms may resemble a heavy menstrual period with cramping and some pain. The later in the pregnancy that a miscarriage occurs, the more likely there will be significant bleeding, “to the point where it leads to anemia in some cases,” said , a reproductive endocrinologist and fertility specialist with CCRM San Francisco. Some people have such heavy contractions that they need pain management, he added. Miscarriages in the second trimester or later may require procedures needing hospital admission. The aftereffects are often unpredictable and can last for weeks or months.

“Miscarriage is not a one-and-done thing at all,” Salem said. “It drags on physically, mentally, and emotionally.”

The emotional aspect “can be a very traumatic experience,” noted , a professor of communications studies at Indiana University who has studied miscarriage for a decade. Some people blame themselves even though the vast majority of early miscarriages are due to chromosomal abnormalities beyond people’s control. Compounding the grief is the lack of established rituals that accompany other losses, as well as a stigma some people attach to miscarriage.

In the wake of such trauma, “it’s very difficult to focus,” Brann said. “An individual is probably not going to be as productive.”

“It is really important that we encourage women to take care of themselves,” Brann said. Otherwise, the grief won’t be processed and it can “cause even greater mental anguish later on.”

More people are speaking out about the experience of miscarriage, including high-profile women like , , and actress .

But many workers find it difficult to get time off from work. The federal Pregnancy Discrimination Act prohibits employers from treating workers who are pregnant, give birth, or have related medical conditions — including miscarriage — worse than comparable co-workers. Courts, however, have interpreted that law differently, even after a decided in favor of a plaintiff who claimed pregnancy discrimination. Judges have dismissed in the aftermath, according to a review by A Better Balance, a national legal nonprofit promoting workplace rights.

— including Colorado — have enacted laws that require employers to offer workers accommodations related to pregnancy, which can include time off to recover from a miscarriage. But outside those states, workers are protected only by the pregnancy act or the Americans with Disabilities Act, if a miscarriage is severe enough to substantially limit a “life activity.”

Currently, , also including Colorado, have enacted laws requiring some employers to provide paid sick leave to workers for medical needs, such as for the physical and mental health impacts of miscarriage. They don’t require employees to say why they need the time off, other than perhaps producing a doctor’s note.

“It’s not putting the onus on the worker to have to reveal something that might be very personal and very sensitive,” said , a senior policy counsel at A Better Balance.

have paid family leave programs, which can be used for more serious complications resulting from miscarriage. Elsewhere workers can take unpaid leave through the Family and Medical Leave Act if they qualify.

To fill the gaps, Sen. Tammy Duckworth (D-Ill.) and Rep. Ayanna Pressley (D-Mass.) that would ensure three days of paid leave for miscarriage and other fertility challenges. Democrats have also put forward to guarantee paid sick leave, and they’ve included paid family leave in President Joe Biden’s social spending plan, although that provision is meeting stiff opposition from some lawmakers and the bill is languishing in Congress.

Makkar is living with the repercussions of her miscarriage. “It’s all so traumatizing still,” she said. She’s trying to find a new job, but the search is complicated. She’s “terrified of getting myself in this situation again,” she said, because she wants to have more children. “I don’t want to be somewhere that that’s not going to be supported.”

This <a target="_blank" href="/mental-health/miscarriage-worker-leave-legislation-pregnancy-benefits-discrimination/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

It was all explained “super quick,” she said, with no details on what the insurance would cover. When she arrived in the United States, she recalled, a representative of the au pair agency recommended she buy extra coverage for sports, because even an accident caused by jumping could be considered sports-related. Mabel opted to purchase the extra policy for an additional $180.

In August 2017, she had her birth control implant removed because it had expired, something she assumed would be covered by her insurance, given birth control coverage is of Mexico’s . Instead, she said, she got a bill for about $4,500. Her insurance didn’t cover contraception or other reproductive health care, she said.

According to the State Department, 14 au pair agencies operate in the U.S. These private companies are required to offer their au pairs basic health coverage under State Department regulations. But some of the plans amount to emergency or travel insurance, excluding many types of necessary care, according to Natalia Friedlander, a staff attorney at the , a nonprofit public interest law center. After an au pair she employed had problems with health coverage, Friedlander examined insurance offered by about half those agencies in 2020 and her center posted to help au pairs find comprehensive coverage.

She found that agencies might not mention that au pairs are eligible to enroll in comprehensive coverage on the Affordable Care Act marketplaces or that many au pairs may qualify for subsidies to help pay their premiums. By failing to enroll, au pairs could wind up with huge medical bills if they need care.

A spokesperson for the State Department said those 14 agencies are subject to the as other groups that sponsor exchange visitor programs and must require the au pairs to “have insurance in effect that covers the exchange visitors for sickness or accidents during the period of time that they participate in the sponsor’s exchange visitor program.” The criteria laid out in the federal regulations include medical benefits of at least $100,000 per accident or illness, a deductible limit of $500 per accident or illness, and a maximum coinsurance limit of 25% of the cost of covered benefits — but they don’t stipulate that the comprehensive coverage required for Americans must be provided.

Neither do the regulations suggest au pairs or other exchange visitors be informed about access to ACA marketplace plans. Mabel and two other former au pairs, whose time working in the program spanned 2014 to June of this year, told KHN that no one ever mentioned the ACA to them when they signed up for work or after they arrived in the U.S.

KHN reached out to each of the 14 au pair agencies under the purview of the State Department about the insurance plans they offer employees. Only one responded.

Terence Burke, a spokesperson for Cultural Care Au Pair, said the insurance offered to its au pairs exceeds regulations set up by the State Department to meet medical expenses and other travel coverage, and provides emergency evacuation from the country if needed, another State Department requirement.

“Au pairs with Cultural Care are given detailed information on exactly what is and what is not covered in their insurance coverage. Knowing that information, au pairs are always free to supplement or add to the insurance coverage they must have in accordance with the U.S. State Department regulations and can choose to enroll in an ACA exchange to supplement their medical coverage,” he wrote in an email.

At least two of the agencies with some of the longest-running programs in the U.S. are owned by companies that also offer insurance. Cultural Care insurance through Erika Insurance, and both companies are EF Education First, a Swedish company. Au Pair in America insurance through Cultural Insurance Services International, both part of the British company American Institute for Foreign Study.

Friedlander found that the insurance plans offered to many au pairs before they arrive exclude certain categories of care deemed essential under the ACA. Many didn’t cover routine or preventive services, or care for preexisting conditions, mental health, and maternity and reproductive health, she said. Some plans are advertised as “comprehensive,” “exceptional” or “worry free,” although they do note the coverage exclusions.

In addition, she said, the insurance coverage summaries or orientation materials she reviewed did not mention ACA marketplace plans as an option.

Au pairs on J-1 visas are classified as foreign nationals living in the U.S. on non-immigrant visas, because they’re not on a path to citizenship. The ACA such non-immigrants. According to a spokesperson for the Centers for Medicare & Medicaid Services, the federal agency that oversees the ACA marketplaces, “We encourage organizations that facilitate the J-1 visa exchange programs to communicate the opportunity to enroll in quality, affordable healthcare through the Marketplace. J-1 visa holders are considered lawfully present and are therefore eligible to enroll in a qualified health plan through the Marketplace, and for financial assistance, if otherwise eligible.”

CMS noted, however, that anyone seeking subsidies to help cover the cost of premiums must plan to file a federal income tax return for that year.

If the insurance au pairs carry through their agencies doesn’t meet the minimum coverage requirements under the ACA, Friedlander said, they are free to enroll.

But the enrollment window is strict: People in the U.S. to sign up for ACA plans outside the annual open enrollment period.

Friedlander said that, when she first looked into insurance for her au pair, “I assumed she would have comprehensive coverage.” She said she was surprised to see large limitations.

Having previously worked at a health insurance-related nonprofit, Friedlander first investigated whether the au pair could enroll in ACA coverage. It took effort because the ACA marketplace navigators weren’t familiar with J-1 visa holders, but she managed to get her au pair enrolled. She has since signed up two of her other au pairs.

But for many au pairs, ACA coverage is not an obvious option. They are typically not native English speakers, very young and living with their employers, which leaves them dependent on their host families. “That’s a situation where they really are reliant on the agencies to provide them information that they need to know while in the United States,” Friedlander said.

For Mabel, her medical bills changed her experience in the U.S. What she owed the hospital and doctor, she noted, would have been enough to buy round-trip tickets to Mexico to have her implant removed there. To save the money to pay off her debt, she said, she stopped doing anything outside of working. “Basically, the purpose of the exchange, go traveling around, it stopped there, it finished, because I acquired this responsibility,” she said. She was able to pay it off over the course of two years, she said.

“It was my biggest mistake, financially talking, of my whole life,” she said.

Estefania Weinbach, of Colombia, said that in 2016, two years after coming to the U.S. to work as an au pair, she experienced a sharp pain in her abdomen that felt like being stabbed. At an emergency room, she was diagnosed with endometriosis and was told she needed surgery within weeks, she recalled.

She said she was told by a representative of her au pair agency that the surgery would be covered in her home country and was advised to fly back immediately. Weinbach refused. The agency told her the insurance would cover surgery expenses up to $7,000, she said, and she found a doctor willing to perform the operation for that payment. But it was a “very traumatic experience,” one that made her feel “everything is against you.”

This <a target="_blank" href="/health-care-costs/au-pair-health-coverage-gaps-affordable-care-act-plans/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">