Some insurance companies consider Caesarean deliveries to be a pre-existing condition, since they increase the likelihood of another C-section. The result is higher premiums or denial, but only for individual policyholders. So a giant, multi-tentacled, unaccountable bureaucracy wants to dictate a One Child Only policy for the self-employed? Who says American industry can't compete with China?
After Caesareans, Some See Higher Insurance Cost [nyt]
Yup, this is my life story. First one, C-section due to breech presentation. Second kid, on our dime completely (ZERO coverage - not even an aspirin). When I was looking for new insurance before I got pregnant for the second time, every single company flat out refused me, and, FYI it wasn't only because of the C-Section. If you're self-insured, it's pretty much impossible to be covered for pregnancy, period (no matter how much more you're willing to pay). One company actually told me that, after I waited the "required SEVEN years between C-Sections," I could pay $100 additional a month, for one year (during which I could also NOT get pregnant), and then, after that year, they would cover $1,500 of my medical expenses. Seriously, someone actually pitched that to me. I laughed. Then I hung up on them.