AMERIKAN EXCEPTIONALISM
High cost of childbirth and postpartum care causes biggest financial hardship for lower-income families with commercial insurance
Medicaid offers greater financial protection than commercial insurance for lower-income families
Columbia University's Mailman School of Public Health
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November 5, 2024-- The cost of childbirth and postpartum health care results in significant, ongoing financial hardship, particularly for lower-income families with commercial insurance according to a Columbia University study. About half of people who give birth in the United States are covered by commercial health insurance, which typically requires cost-sharing in the form of deductibles, copayments, and coinsurance. The study is published in the Milbank Quarterly.
Researchers Jamie Daw, PhD, of Columbia University Mailman School of Public Health, and Heidi L. Allen, PhD, of the Columbia University School of Social Work surveyed a representative sample of 4,453 postpartum people; 1,544 with a Medicaid-insured birth and 2,909 commercially insured, from the Postpartum Assessment of Health Survey (PAHS). A follow-up survey was conducted among participants in the CDC Pregnancy Risk Assessment Monitoring System (PRAMS) 12 to 14 months after giving birth in 2020 in six states—Kansas, Michigan, New Jersey, Pennsylvania, Utah, Virginia – and New York City. The survey included questions on health care costs and financial well-being.
The researchers found:
- Over half of respondents with commercially insured births spent more than $1,000 out of pocket on childbirth and nearly 40 percent reported being somewhat or very worried about paying health care bills.
- Lower income people (with annual incomes of less than about $60,000) with commercially insured births reported particularly high financial strain:
- nearly half still owed money for childbirth costs,
- 16 percent had not made any payments yet, and
- 1 in 5 had medical debt in collections.
Overall, Medicaid was financially protective for birthing families relative to commercial insurance. The vast majority of people with a Medicaid-covered birth did not have any out-of-pocket spending on childbirth or health care in the postpartum year (80 percent). However, even small amounts of cost-sharing were associated with outstanding medical debt. Among Medicaid enrollees with any OOP spending for childbirth, 1 in 3 still owed money and over 1 in 4 had not made any payments 12 to 14 months after birth.
“Out-of-pocket costs related to childbirth or postpartum care come at a time of financial vulnerability for families,” Allen said. “There are significant costs associated with a new baby, including diapers and childcare. Additionally, many people take unpaid family-leave and some reduce their hours at work. Making childbirth more affordable should be a public policy priority.”
To ease the financial burden for people with Medicaid, Daw and Allen propose that the Centers for Medicare and Medicaid Services or states eliminate all cost-sharing for pregnant and postpartum people in Medicaid and the Children’s Health Insurance Program, which covers pregnancy for women with incomes above the Medicaid threshold in some states. Commercial insurance solutions might include allowing lower-income birthing people to apply for supplemental Medicaid coverage; exempting certain pregnancy and postpartum services from cost-sharing; and state actions to relieve the burden of medical debt.
“Policies to improve the affordability of childbirth can also be viewed as investments in early child health and development. “It is important to think about the trade-offs families may be forced to make between paying off medical debts related to childbirth and providing their children with resources—like healthy food, adequate housing and quality childcare—that are important for them to thrive,” said Daw, assistant professor of Health Policy and Management at Columbia Mailman School. “This is an often-overlooked consequence of the high medical costs of childbirth in the United States.”
Co-authors are Chen Liu, Columbia University Mailman School of Public Health; Mandi Spishak-Thomas, PhD, of the Rutgers Center for State Health Policy, and Kristen Underhill, Cornell Law School.
About the Milbank Memorial Fund
The Milbank Memorial Fund is an endowed operating foundation that works to improve population health and health equity by collaborating with leaders and decision makers and connecting them with experience and sound evidence. The Fund is the publisher of the editorially independent Milbank Quarterly, a peer-reviewed multidisciplinary journal of population health and health policy continuously published since 1923.
About Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.
Journal
Milbank Quarterly
Article Title
When the Bough Breaks: The Financial Burden of Childbirth and Postpartum Care by Insurance Type
