The expenses associated with childbirth and postpartum care can lead to severe financial difficulties, especially for low-income families who have commercial health insurance. Around 50% of individuals giving birth in the U.S. are insured through commercial health plans, which usually necessitate cost-sharing, including deductibles, copayments, and coinsurance.
The financial impact of childbirth and postpartum health care is considerable and often ongoing, particularly for low-income families enrolled in commercial insurance, as stated in a study from Columbia University. Approximately half of those who give birth in the United States are covered by commercial health insurance, usually requiring some form of shared costs such as deductibles, copayments, and coinsurance. This research appears in the Milbank Quarterly.
Researchers Jamie Daw, PhD, from the Columbia University Mailman School of Public Health, along with Heidi L. Allen, PhD, from the Columbia University School of Social Work, conducted a survey involving a representative group of 4,453 postpartum individuals. This sample included 1,544 births covered by Medicaid and 2,909 with commercial insurance, gathered from the Postpartum Assessment of Health Survey (PAHS). A follow-up was performed among participants in the CDC Pregnancy Risk Assessment Monitoring System (PRAMS) 12 to 14 months following childbirth in 2020 across six states: Kansas, Michigan, New Jersey, Pennsylvania, Utah, Virginia, and New York City. The survey asked about health care expenses and financial well-being.
The findings revealed:
- More than 50% of those with commercial insurance for childbirth spent over $1,000 out of pocket, and nearly 40% expressed significant concern regarding their ability to pay healthcare bills.
- Individuals with lower incomes (less than approximately $60,000 annually) who had commercially insured births experienced even greater financial stress:
- close to half still had outstanding payments for childbirth costs,
- 16% had yet to make any payments, and
- 20% faced medical debt in collections.
In contrast, Medicaid appeared to provide better financial security for birthing families when compared to commercial insurance. The vast majority of those who had a Medicaid-covered birth (80%) did not incur out-of-pocket expenses related to childbirth or healthcare during the year postpartum. However, even minor costs were linked with outstanding medical debt. Among Medicaid recipients who did have out-of-pocket expenses for childbirth, one-third still owed money, and more than a quarter had not made any payments 12 to 14 months after giving birth.
“Out-of-pocket costs associated with childbirth or postpartum care arise at a time when families are already experiencing financial strain,” Allen remarked. “Having a new baby brings significant expenses, such as diapers and childcare. Many individuals also take unpaid family leave or reduce their work hours. Making childbirth more affordable is a crucial public policy issue.”
To alleviate financial stress for Medicaid recipients, Daw and Allen recommend that the Centers for Medicare and Medicaid Services, or individual states, eliminate all cost-sharing for pregnant and postpartum individuals in Medicaid and the Children’s Health Insurance Program (CHIP), which provides coverage for pregnancy for women with incomes above the Medicaid limit in some areas. Solutions for commercial insurance could include allowing lower-income birthing people to apply for additional Medicaid coverage or exempting certain pregnancy and postpartum services from cost-sharing requirements, along with state initiatives to ease the burden of medical debt.
“Policies aimed at making childbirth more affordable should also be seen as investments in the early health and development of children. It’s crucial to consider the sacrifices families may have to make between repaying medical debts and providing essential resources—like nutritious food, stable housing, and quality childcare—for their children’s well-being,” stated Daw, who is an assistant professor of Health Policy and Management at Columbia Mailman School. “This issue of high childbirth costs in the United States often goes unnoticed.”
Co-authors include Chen Liu from Columbia University Mailman School of Public Health, Mandi Spishak-Thomas, PhD, from the Rutgers Center for State Health Policy, and Kristen Underhill from Cornell Law School.
