Could Childbirth Be Free?

Maybe! Or so some in Congress think.

Imagine if child birth costs were covered entirely by your health insurance? Setting aside the problem this could create for people without private health insurance, it’s a step in the right direction to make things easier for families. Photo by Christian Bowen on Unsplash

In spring of 2015, I became pregnant with our second child. His due date was New Year’s Eve. Which meant that as I went through all my prenatal appointments and ultrasounds we slowly ate through the very high deductible on my health care plan*. Yet, he took his time and didn’t arrive until January 2016, right around the time that most people were starting to resume life and work post-holiday.

But our deductible had already rolled over.

After he was born, a woman stopped by our room in the hospital, clipboard in hand, asking for my credit card. I paid the balance that day: $3000.

Had he been born on his due date, I’d have been covered. Balance: 0.

I’m now in a place where my childbirth days are behind me. I’m still flooded with affection when I see pictures of my children at the baby phase, but for us the expansion era is over.

But it didn’t stop me from feeling a moment of “about damn time!” when I saw Rachel Cohen’s article in Vox about a bipartisan bill in Congress to have health insurance companies cover all the costs associated with childbirth, prenatal and postnatal care. The Supporting Healthy Moms and Babies Act**, introduced in the Senate, would require private insurance companies to fully cover all costs related to the birth of a child. If you are fortunate to have insurance through your employer or your state, it would be one fewer bill to grapple with at one of the most vulnerable moments in your life.

What’s fascinating about this bill isn’t its straightforward pragmatism - we should be focused on making sure anyone who is ushering a human into this world can do so safely - it’s that the bill is a vestige of bipartisan legislating. It brings together the traditional right-wing pronatalism and pro life sides of the aisle with the progressive left and pro-choice side, who see value in providing free or low-cost health care services more broadly.

The price tag for premiums for covering child birth? $30 increase per year. Less than a cup of coffee per month. Photo by Kenny Eliason on Unsplash

So here is why I am excited to see this bill, and also what makes me nervous about it.

—> Some of the good:

1. We have seen the way policies can shape our health care systems. The ways in which private health insurance reimburses people for services drastically shape health care decisions. Before Obamacare, health insurance companies didn’t have to cover the cost of a breast pump. The Affordable Care Act changed this, once the cost of a breast pump became FREE, more women on private insurance requested pumps, and this has been associated with higher rates of breastfeeding.

2. The price tag on this proposal is laughably low. According to an analysis by the Niskanen Center, by having private insurance companies pay for all costs related to childbirth and pre- and post-natal care, premiums would go up by approximately $30 PER YEAR. Spread that over 12 months, and that is less than a cup of coffee.

3. I worked on Capitol HIll when we passed the Affordable Care Act, for a Senator who was a staunch defender of the public plan, which never took flight. Absent public health insurance options, we need more policies that dictate to health insurance companies their need to pay for such things.

5. Finally, it’s about damn time that both sides worked together on something that they each have a stake in: healthy, thriving families. We know that better health care leads to better outcomes for mothers and babies. For all the clamoring about pronatalism and what it means to encourage having more babies and who wins and loses when that happens, I’ll take less rhetoric and more policies like this please.

And here are the reasons why I’m nervous:

1. Private insurers don’t always play well with others. They are some of the savviest in the business at lobbying Congress to turn a profit. In 2023, federal subsidies for health insurance are estimated to be $1.8 trillion, or 7.0 percent of GDP. The Congressional Budget Office did a 10 year forecast and predicted that this will continue to increase, reaching $3.3 trillion, or 8.3 percent of GDP, in 2033. Considering how much government spending goes to these companies, it’s a reasonable expectation that certain parameters should be established - among them, covering all childbirth and prenatal and postnatal care.

2. Introducing a bill is a good start - but it’s not usually newsworthy because the bill has a long way to go before ever seeing the pointed end of a signing pen. It’s notable because it’s a fascinating coalition to tackle a topic that would impact so many families - but it’s still a long way from changing things. Rachel Cohen’s story goes into more detail about the how and why of this coalition coming together.

3. Childbirth is such an important starting point for families. But then it’s over, recovery is underway, and there is still the baby to raise and bills to pay. As much as I am psyched to see this particular policy, it’s still not the sort of comprehensive care policy needed to make things easier with families. This, in my opinion, is more similar to the Administration's idea with the $5000 baby bonus for new parents - that would be a great break for families at this pivotal, vulnerable time, but it isn’t the sort of long-term, sustained investment in families that we still need. But it’s a good place to start.

*I feel compelled to clarify this every time I write about it, but I was incredibly lucky to have health insurance during the births of our kids, and I came very close to losing it when I was laid off during my pregnancy with my oldest, something I’ve written about before and think is a telling example of what is wrong with relying entirely on private companies to do the work of caring for people in vulnerable times.

**Cute title and all, but we should also be very up front about how helping families pay for the birth of a child helps dads too.