Make birth free

To address the predictable objections: Yes, the costs of pregnancy, childbirth, and postpartum care really do spell the difference between life and death for scores of American mothers and infants. Preventing preterm births and safeguarding babies’ health in the first few months of life would likely reduce relatively high American infant mortality rates to levels closer to those of our peer nations, many of which spend much more than we do on mothers and babies. Likewise, a 2020 report issued by the Commonwealth Fund on maternal mortality in the U.S. observed that barriers to prenatal and postpartum care—namely non-insurance and poorly crafted Medicaid policies that drop new mothers from expanded postpartum coverage only 60 days after birth—contribute a great deal to maternal death. In a country where health care can be cost-prohibitive, deaths arising from inadequate or inaccessible care might as well be tallied as deaths from poverty.

This is especially the case with respect to pregnancy, birth, and postnatal care, all of which range from manageably costly to exorbitantly expensive. For many, private insurance is hardly a comfort. Young mothers enrolled as adult dependents on their parents’ private health-insurance plans may not discover that their benefits don’t extend to maternity care until their multithousand-dollar bills for routine obstetrician visits arrive. The costs associated with childbirth itself are even more harrowing. A recent study published by the American Academy of Pediatrics found that the average out-of-pocket expense for giving birth while privately insured exceeds $3,000. More than one in six privately insured births result in more than $5,000 of out-of-pocket expenses. Over the course of reporting this story, I encountered mothers across the country who shared extraordinary medical bills from having given birth: A hospital in Texas charged one couple north of $10,000 for labor and delivery, with some $3,000 paid out of pocket in the run-up to the due date, and another $1,500 charged after the birth; in Indiana, a high-risk delivery this year totaled more than $24,000; in Colorado last year, a hospital sent a mother a $14,000 bill for her uncomplicated hospital delivery without so much as an epidural, $5,000 of which she was forced to pay out of pocket.