This article was originally published by The 19th on July 13, 2022.
The out-of-pocket cost of giving birth with insurance is $2,854, according to a new analysis released Wednesday by the nonpartisan Kaiser Family Foundation (KFF).
The analysis comes after the Supreme Court’s landmark decision to overturn Roe v. Wade, the 1973 case that guaranteed abortion rights. The June 24 decision gave states the power to ban the procedure. In the past two-and-a-half weeks, eight states have begun imposing outright bans on abortion. Three more countries actively ban the procedure for people after six weeks of pregnancy.
Giving birth is only the first expense – raising a child comes with its own financial burden, and previous research has shown that people who are denied an abortion face significant economic damage. A project known as the Turnaway Study found that 72 percent of people who were unable to get an abortion they wanted lived in poverty, compared to 55 percent of those who were able to terminate a pregnancy.
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KFF’s analysis builds on this understanding, illustrating just one of the additional costs incurred by childbirth. It offers a snapshot of the financial burden associated with pregnancy and highlights that many Americans cannot afford to give birth.
“There will be more women who end up giving birth at term because they didn’t have access to timely abortion or abortion at all.” That could mean they have very significant costs,” said Cynthia Cox, vice president of KFF and author of the study. “That’s the first cost they would experience, the cost of giving birth. But, of course, there are other costs – the costs of health care for babies and child care and support for many years afterwards.
Out-of-pocket costs represent insurance-related bills related to pregnancy, labor and delivery, and postpartum care. The researchers analyzed a set of health insurance claims data from 2018 to 2020, comparing women between the ages of 15 and 49 who had given birth to those who had not. The data does not account for transgender and non-binary people who may have given birth.
In total, pregnancy and childbirth for someone with private insurance costs about $18,865. Most of this is paid for by the insurance plan, but may result in higher insurance premiums in the future. So even though the $2,853 figure is only one part of the total cost, it represents the bills new parents have to foot alone for a single birth.
By comparing cumulative medical costs for women who had given birth and those who had not, the analysis captured a more complete picture of how expensive childbirth can be. Out-of-pocket costs include psychiatric care, prenatal visits, and other medical services that may not be labeled “birth-related” but are a direct result of the pregnancy and carrying that pregnancy to term. Childbirth cost analyzes typically focus only on the cost of labor and delivery.
But if anything, the paper underestimates the cost of pregnancy, Cox said. The nulliparous category includes people who have been pregnant for a period of time but may have miscarried or miscarried. This means they have incurred some costs related to the pregnancy, but not all.
The study only looked at people insured through private health plans sponsored by large employers. About half of all births are covered by private insurance — most others are covered by the public Medicaid program, which covers low-income people and has fewer associated out-of-pocket costs.
Of the private plans, large employer-sponsored plans tend to be the most generous. People with other forms of private coverage — small employer-sponsored insurance or a plan purchased on the individual market — likely face even higher out-of-pocket medical costs when they give birth, Cox said.
The findings underscore that although millions of Americans have lost the ability to terminate pregnancies, childbirth remains overwhelming for many Americans. A previous KFF analysis found that 45 percent of single-person households do not have more than $2,000 to pay medical bills. Almost a third of multi-member households similarly do not have enough money to cover pregnancy and birth expenses out of pocket.
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“These costs are more than many families can afford,” the report said.
High-risk pregnancies, which more often result in C-sections, also result in higher out-of-pocket costs, according to the paper. Cox suggested that this might take on particular importance in a post- Roe world. Abortion bans can lead to more people having high-risk pregnancies — forcing patients to endure increased, potentially life-threatening medical risk and also shoulder even more financial burdens.
And the analysis notes that out-of-pocket medical bills are just one cost issue. Because KFF’s analysis looked at health insurance claims data, it did not account for potential patient costs for over-the-counter drugs not covered by insurance, such as prenatal vitamins.
And there are costs beyond medical bills that a pregnant woman faces. When giving birth, people can give up wages if their job does not guarantee paid parental leave. Caring for a new child can mean incurring other new expenses such as health care for the baby and new non-medical expenses. The loss of income combined with new financial burdens increases new parents’ risk of medical debt. Current parents are also more likely to already have medical debt.
“That’s probably the smallest cost,” Cox said. “This is the first of many.”