Insurance should cover full cost of pregnancy

Women shouldn't choose between care and incurring debt

IN MASSACHUSETTS, we pride ourselves on our healthcare leadership — the first state to achieve near-universal health insurance coverage, home to some of the most celebrated healthcare institutions in the world, at the forefront of efforts to address racial disparities, ensure access to comprehensive reproductive care, and more.

But underneath that legacy of progress are persistent barriers to care that impact thousands of people in communities every year; barriers that lead to worse health outcomes, and deepen economic, gender, and racial inequities. One urgent example: the cost of care for new and expecting mothers and pregnant persons.

Today, even as the vast majority of Massachusetts residents have health insurance coverage, state law permits “cost sharing” between the insurer and the insured for maternity care – including prenatal care, childbirth, and postpartum care as well as miscarriage management and abortion care.

It’s tempting to think of insurance as a lifeline, a safety net when individuals and families are faced with mounting healthcare costs, but a staggering 85 percent of Bay Staters who reported having medical debt incurred their debt while insured, many due to costs associated with pregnancy and childbirth. Deductibles and copays that can run into the thousands – or even tens of thousands of dollars – mean that women and families are too often forced to choose between foregoing necessary pregnancy care or shouldering enormous financial burden.

The impact of cost sharing isn’t theoretical.

When Melissa gave birth to her first child, it cost her nearly $10,000 out of pocket, even though she had insurance. Nearly three years later, she’s still paying off the bills — forcing her to delay decisions about having more children and forgo her own medical care because of the extra financial burden.

Joyce had 4 miscarriages and one live birth. After her last miscarriage, she was hospitalized for a week, and her high-deductible insurance left her on the hook for thousands of dollars, on top of the costs associated with child care and psychological counseling.

Karen is a special education teacher in her thirties. She has insurance and she wants to have a child, but she’s still hesitant because she knows that the out-of-pocket cost of pregnancy care and childbirth could leave her financially unable to care for herself or her child.

What’s clear: the financial realities of pregnancy and childbirth in Massachusetts, and the near-impossible decisions those realities create, can fundamentally alter the future trajectory of individuals, families, and entire communities.

And the inequitable burden of cost-sharing only exacerbates long-term economic, gender, and racial inequities. Overall, women shoulder a disproportionate percentage of out-of-pocket healthcare spending. Maternal care is both one of the most common reasons people seek care and hospitalization, and it’s one of the most expensive; a major reason that women between the ages of 19 and 44 routinely spend as much as 62 percent more per capita on health care costs than their male counterparts.

Black and Brown women are among the most likely to report issues paying for care, or to engage in “self-managed” care. How can we claim to be a leader on racial equity when Black birthers continue to disproportionately experience preterm birth, infant mortality, and maternal mortality and shoulder the lion’s share of cost? We can’t.

If we are serious about the pursuit of healthcare justice, economic justice, and racial justice in Massachusetts, it’s clear that we must eliminate financial barriers to comprehensive pregnancy care. The good news? There’s a bill to do just that on Beacon Hill.

An Act ensuring access to full spectrum pregnancy care would require health insurance plans to cover all pregnancy related care, including prenatal care, childbirth, postpartum care, miscarriage management, and abortion care without any kind of cost-sharing. This would mean that women covered by state-regulated insurance in Massachusetts would be able to access medically necessary reproductive healthcare. This would help reduce economic disparities and enable doctors and patients to make the medical decision that is best for the patient without fear of cost or crippling medical debt, and would empower women to decide how and when they want to bear children.

For too long in Massachusetts, we’ve simply accepted that pregnancy care has to break the bank. It’s been a fact of life that for some, the joy of childbirth will be clouded by financial considerations, while for others the pain and trauma of complications or miscarriage will be compounded by thousands of dollars in medical bills.

Meet the Author

Nneka Hall

Full spectrum doula/Founder, Quietly United In Loss Together
Meet the Author

Rebecca Hart Holder

Executive director, Reproductive Equity Now
But it doesn’t have to be that way. By passing An Act ensuring access to full spectrum pregnancy care, and making an investment equal to less than one-tenth of 1 percent of all healthcare spending in Massachusetts, we can eliminate cost-sharing for pregnancy care. By doing so, we can help guarantee that no person is expected to choose between critical care for themself or their child, or taking on thousands in medical debt. We can make meaningful progress towards greater economic, gender, and racial equity in our state. The time to act is now.

Nneka Hall is a full spectrum doula, maternal and fetal health advocate, and founder of Quietly United in Loss Together (QUILT). Rebecca Hart Holder is the executive director of NARAL Pro-Choice Massachusetts