fbpx The True Cost of Our Broken Healthcare System

The True Cost of Our Broken Healthcare System

The financial burden of pregnancy and childbirth can be devastating for new families.
Alex Denny
Written by

Alex Denny

The costs throughout your pregnancy will vary depending on your unique circumstances and the choices you make. Do you choose a midwife or an OB-GYN? A whole new maternity wardrobe or a few upsized bras? A home birth or a hospital room? And these choices are just the start. The first year postpartum comes with a host of costs, including childcare, formula, diapers, nursery items and more.

The average middle-class family spends $17,000 in the first year of life of their first child. This amount increases as the child gets older. The high cost of pregnancy and childbirth runs the risk of setting families back so they can't provide as much for their children in early childhood.

While these individual decisions add up, the largest discrepancy in pregnancy and early motherhood costs comes from insurance coverage. And even insurance can't guarantee a low-cost pregnancy. With high deductibles—the amount you pay before insurance steps in—most mothers can expect to shell out thousands of dollars.

Parents who lack insurance or are utilizing out-of-network care could face a wide range of bills, depending on the complexity of labor and location. In New York City, for example, a C-section can run $16,000 out-of-pocket. Mothers with Medicaid can expect near-full coverage of all prenatal, inpatient and postnatal care, but may face difficulties with their state's changing views of what is considered necessary (i.e., covered) and the quick cutoff of coverage at 60 days postpartum.

With all of that said, what can be done to ease the financial burden of pregnancy and early motherhood? One major way to create change lies in legislation. Passing bills to limit hospital fees and early childcare costs, increasing funding for children's resources and providing more healthcare coverage would make a huge difference.

The Build Back Better Act

A proposed 2021 bill would address many of these issues: the Biden administration's Build Back Better Act. The act, touted as the "most transformative investment in children and caregiving in generations," would address some of the gaps in our healthcare system in the following ways:

  • Provide subsidized coverage through the federal health insurance marketplace for individuals with income less than 138 percent of the federal poverty level in order to temporarily close the Medicaid coverage gap—offering more parents and parents-to-be necessary coverage.
  • Make federal funding for the Children's Health Insurance Program (CHIP) permanent. CHIP perinatal coverage provides care to unborn children and expands the reach of Medicaid.
  • Medicaid and CHIP would provide 12 months of postpartum coverage.
  • Funding would be allocated to numerous maternal and child health initiatives, including addressing maternal mental health, minority maternal mortality outcomes and the education/training programs for maternal healthcare workers, among others.
  • Establish permanent, mandatory paid family leave for up to four weeks.
  • Secure free preschool for all children ages 3 to 4, and increase access to early childcare by ensuring middle-class families pay no more than 7 percent of their income for childcare.
  • Support easier access to childcare through the childcare tax credit and grants to improve the safety of childcare sites.

And, that's just some of what the act would cover. Proponents of the bill also say it aims to decrease pharmaceutical costs, promote nutritional security and ensure affordable housing—all of which would have a major impact on childcare.

Opponents of the Build Back Better Act note the overall increase in taxes, and some pharmaceutical companies are displeased with the possibility of the government controlling drug prices. Some hospitals may also be wary of the cuts to disproportionate share hospital (DSH) payments, which are intended to offset care costs for uninsured patients and patients with Medicaid.

The largest discrepancy in pregnancy and early motherhood costs comes from the level of insurance coverage.

A single-payer healthcare system

Regardless of proposed legislation, a larger, more permanent solution would be to overhaul the healthcare system. Single-payer healthcare, also known as Medicare for All, is a type of universal healthcare in which essential medical care is covered by one public system.

If the government were to fund comprehensive coverage for all, pregnancy costs—such as OB-GYN appointments and testing, labor and delivery, hospital stays and early childcare medical needs—would all be covered. These changes could be life-changing for millions of families and allow young people the opportunity to start family planning with some sense of security that pregnancy and childcare won't cripple their savings.

With maternity mortality rates as high as they are in the United States, universal coverage could ensure pregnant people get the reproductive healthcare they need throughout their pregnancy (as well as before and after) to safely conceive and deliver.

If women cannot afford sufficient prenatal care, both mother and baby are at risk of complications leading to death. The United States ranks last in maternal mortality in industrialized countries, with a rate of 17.4 deaths per 100,000 pregnancies. And Black women are significantly more impacted, dying at a rate of 2.5 times that of white women.

Barriers to single-payer healthcare include public support, costs and the fear that a universal system could lead to lower-quality individual care.

What else can be done to lower the cost of pregnancy?

Sweeping legislative changes and healthcare overhauls aside, what can be done right now to lower costs for pregnant people? Without systemic changes, it's impossible to ensure a low-cost pregnancy, childbirth or early motherhood. However, for the newly pregnant or people trying to conceive, there are a few money-saving routes possibly worth trying:

  • If financially possible, shop around to get the best insurance coverage. Good insurance can make all the difference in that final hospital bill. You can always downgrade insurance again the following year.
  • Women with normal, low-risk pregnancies could consider hiring a midwife instead of an OB-GYN. Midwives often result in decreased intervention and fewer C-sections, which are significantly more expensive than vaginal births.
  • Opt for used maternity clothes and hand-me-down baby items. Baby stuff can get expensive very quickly and becomes redundant as your baby grows. Secondhand or rental items can significantly decrease costs.
  • Join a community group for emotional support and advice. Other moms can probably give you a better idea of what items you actually need or the various options you may need to choose from while pregnant. And the connections you'll form could be useful beyond financial means.

Pregnancy and childbirth often go unplanned, and bills can add up quickly. If we don't see a larger change in this country, new parents will continue to face an uphill battle of untenable medical bills, expensive (or nonexistent) childcare, and the undue stress of bearing a child into a country that does not function to support new parents.