This article was originally published by The 19th on July 13, 2022.
The out-of-pocket cost of an insured birth 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 in 1973, which guaranteed the right to abortion. The June 24 decision gave states the power to ban the practice. In the past two-and-a-half weeks, eight states have begun implementing total abortion bans. Another three states actively ban the procedure for people after six weeks of pregnancy.
Giving birth is only the first cost – raising a child is a financial burden of its own, and previous research has shown that people who are denied an abortion face significant economic harm. The project, known as the Turnaway Study, found that 72 percent of people who didn’t have access to 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 and illustrates just one of the excessive costs that arise during childbirth. It offers an overview of the financial burden associated with pregnancy and emphasizes that many American women cannot afford to give birth.
“There will be more women carrying to term because they have not been able to get an early abortion or an abortion at all. So that can mean they have very significant costs,” said Cynthia Cox, vice president of KFF and author of the study. “This is the first cost they experience, the cost of giving birth. But of course there are other costs – the costs of the infants’ health care and their childcare and support for many years to come.”
Out-of-pocket costs are insurance-related bills related to pregnancy, labor and delivery, and postpartum care. Researchers analyzed a set of health insurance claims data from 2018 to 2020, comparing women ages 15 to 49 who gave birth to those who did not. The data does not take into account transgender and non-binary people who may have given birth.
In total, pregnancy and childbirth cost about $18,865 for someone with private insurance. Most of this is covered by the insurance plan, but may result in higher premiums. So while the $2,853 figure is only a fraction of the total cost, it represents the bills new parents have to pay themselves for one birth.
By comparing cumulative health care costs for women who gave birth and those who did not, the analysis captured a more complete picture of how costly childbirth can be. Out-of-pocket costs included psychiatric care, prenatal visits, and other medical services that may not be labeled “birth-related” but that directly result from the pregnancy and carrying the 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 category of people who have not given birth includes people who have been pregnant for a while, but may have miscarried or had an abortion. This means that they incurred some of the costs related to the pregnancy, but not all of them.
The study only looked at people insured through large private employer-sponsored health plans. About half of all births are covered by private insurance—most of the rest are covered through 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 are usually the most generous. People with other forms of private coverage — small employer-sponsored insurance or a plan purchased on the individual market — likely faced even higher health care costs at birth, Cox said.
The findings underscore that even as millions of Americans have lost the ability to terminate a pregnancy, childbirth remains out of reach for many Americans. A previous KFF analysis found that 45 percent of single-person households did not have more than $2,000 available to pay medical bills. Similarly, almost a third of multi-member households do not have enough cash to cover their own expenses for pregnancy and childbirth.
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“These costs are more than many families can afford,” the report said.
High-risk pregnancies, which lead to C-sections more often, also resulted in higher out-of-pocket costs, the paper says. Cox suggested that this could take on particular significance in a post-Roe world. A ban on abortion could lead to more people with high-risk pregnancies giving birth – forcing patients to bear increased, potentially life-threatening health risks and also shouldering an even greater financial burden.
And the analysis notes that medical bills are just one cost issue. Because the KFF analysis looks at health insurance claims data, it does not account for potential patient spending on over-the-counter medications that are not covered by insurance, such as prenatal vitamins.
And there are costs beyond medical fees that a pregnant person faces. After giving birth, people can give up their wages if their job does not guarantee paid parental leave. Caring for a new baby can mean additional new expenses, such as infant health care and new non-medical costs. The loss of income combined with a new financial burden increases the risk of medical debt for new parents. Current parents are also more likely to already have medical debt.
“This is perhaps the smallest cost,” Cox said. “It’s the first of many.”